Chronic Disease Epidemiology Division, Yale School of Public Health.
Hepatocellular carcinoma (HCC) has a poor prognosis and, unlike most cancers, HCC incidence and mortality rates are increasing in the United States. While risk is known to vary among different racial and ethnic groups, less is known about the variability of risk within these groups by neighborhood socioeconomic status (SES).
HCC cases diagnosed in the Surveillance, Epidemiology and End Results (SEER) 11 cancer registries between 1996 and 2007 and the population of the SEER 11 catchment areas were studied. Analyses were performed to compare census-tract area family poverty, educational attainment and unemployment by race and ethnicity. A multiple linear regression model, weighted by the number of cases and the number of individuals in each census-tract, with adjustment for registry, was used to calculate mean differences in area-level attributes between HCC cases and the population.
HCC cases in most racial/ethnic groups had lower mean neighborhood-level measures of SES than their referent population. An exception was seen among Hispanics. Comparing white cases to cases of other racial groups and to Hispanics, white cases lived in neighborhoods with less family poverty, fewer high school dropouts, and lower unemployment. Compared to white cases, Asian and Pacific Islander and Hispanic cases lived in neighborhoods with higher percent foreign born population.
Low neighborhood-level SES and immigrant status may be associated with greater risk of HCC within specific racial and ethnic groups. Impact: These findings could help to focus control resources for HCC toward the most affected communities.