Local Geographic Variation in Chronic Liver Disease and Hepatocellular Carcinoma: Contributions of Socioeconomic Deprivation, Alcohol Retail Outlets, and Lifestyle
A partir des données de la cohorte "NIH-AARP Diet and Health Study" portant sur 434 cas, cette étude américaine analyse les disparités géographiques dans l'incidence de maladies chroniques du foie et du carcinome hépatocellulaire, en prenant en compte des facteurs de risques socio-économiques, l'accès à la vente d'alcool ou aux infrastructures de santé
Purpose : Hepatocellular carcinoma (HCC) incidence rates continue to increase in the United States. Geographic variation in rates suggests a potential contribution of area-based factors, such as neighborhood socioeconomic deprivation, retail alcohol availability, and access to healthcare. Methods : Using the NIH-AARP Diet and Health Study, we prospectively examined area socioeconomic variations in HCC incidence (n=434 cases) and chronic liver disease (CLD) mortality (n=805 deaths) and assessed contribution of alcohol outlet density, healthcare infrastructure, diabetes, obesity and health behaviors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from hierarchical Cox regression models. Results : Area socioeconomic deprivation was associated with increased risk of HCC incidence and CLD mortality (HR=1.48,95%CI:1.03-2.14 and HR=2.36,95%CI:1.79-3.11, respectively) after accounting for age, sex, and race. Additionally accounting for educational attainment and health-risk factors, associations for HCC incidence were no longer significant; associations for CLD mortality remained (HR=1.78, 95%CI:1.34-2.36). SES differences in alcohol outlet density and health behaviors explained the largest proportion of SES-CLD mortality association, 10% and 29%, respectively. No associations with healthcare infrastructure were observed. Conclusions : Our results suggest a greater effect of area-based factors for CLD than HCC. Personal risk factors accounted for the largest proportion of variance for HCC, but not for CLD mortality.