Geographic variation within the United States in the incidence of hepatocellular carcinoma
Geographic variation within the United States in the incidence of hepatocellular carcinoma
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DOI：
10.1016/s0895-4356(02)00605-4
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发表时间：
2003-05-01
影响因子：
7.2
通讯作者：
El-Serag, HB
中科院分区：
文献类型：
--
作者：
Davila, JA;Petersena, NJ;El-Serag, HB
在美国，肝细胞癌（HCC）的地理变异以前没有研究过。利用监测、流行病学和最终结果登记处（SEER）和1990年行为危险因素监测系统（BRFSS）收集的数据，我们分析了美国9个地理区域HCC的发病率和危险因素。我们确定了1975-1998年期间五个州（康涅狄格州、爱荷华州、犹他州、新墨西哥州和夏威夷）和四个大都市区（底特律-大都市区、旧金山-奥克兰区、西雅图-普吉特海湾区和亚特兰大-大都市区）的所有HCC患者。计算每个地理区域的经性别调整的发病率。在Poisson多变量回归模型中检查HCC发病率和地理区域之间的关联，控制年龄、性别、种族和诊断年份。分层线性模型也被用来检查这些关联，同时调整地理区域内具有相似特征的人的潜在聚类，并评估这些地理区域内基础人群中吸烟、饮酒、肥胖和糖尿病患病率的影响。共检查了11，547名HCC患者。夏威夷的年龄校正发病率最高（4.6），其次是旧金山-奥克兰（3.2）、新墨西哥州（2.0）、底特律-大都会（1.9）、西雅图-普吉特湾（1.8）、亚特兰大-大都会（1.7）、康涅狄格州（1.6）、爱荷华州（1.1）和犹他州（1.0）;所有的发病率均为每10万人。白人的年龄调整发病率为1.5，黑人为3.2，其他种族“亚洲人、美洲印第安人、太平洋岛民”为7.0。然而，西雅图-普吉特湾的黑人和“其他种族”的年龄调整发病率（分别为4.4和8.2）高于任何其他登记处的黑人和其他种族，而夏威夷的白人的发病率（2.5）高于任何其他登记处的白人。一般来说，男性的年龄调整发病率比女性高两到三倍。然而，夏威夷男性的年龄调整率（7.0）明显高于其他地区的男性，而犹他州男性的HCC发病率最低（1.5）。调整种族、性别、年龄和诊断时间的差异后，Poisson回归分析显示HCC的持续地理差异以及顺序的变化，新墨西哥州HCC发病率最高，其次是旧金山-奥克兰。分层线性模型证实了HCC的地理差异，但未能显示对基础人群中吸烟、饮酒、肥胖和糖尿病的患病率有显著影响。在美国，HCC发病率存在显著的地理差异。这些差异仅部分由年龄，性别，种族和诊断年份的差异解释。(C)2003爱思唯尔公司All rights reserved.
Geographic variation in hepatocellular carcinoma (HCC) has not been previously studied in the United States. Using data collected by the Surveillance, Epidemiology, and End Results registries (SEER) and the 1990 Behavioral Risk Factor Surveillance System (BRFSS), we analyzed incidence and risk factors for HCC in nine geographic regions in the United States. We identified all individuals with HCC during 1975-1998 in five states (Connecticut, Iowa, Utah, New Mexico, and Hawaii) and four metropolitan areas (Detroit-Metropolitan, San Francisco-Oakland, Seattle-Puget Sound, and Atlanta-Metropolitan). Age-adjusted incidence rates were calculated for each geographic region. The association between HCC incidence and geographic regions were examined in Poisson multivariate regression model controlling for age, gender, race, and year of diagnosis. Hierarchical linear modeling was also used to examine these associations while adjusting for potential clustering of persons with similar characteristics within geographic regions, and to assess the effect of the prevalence of smoking, alcohol use, obesity, and diabetes in the underlying population in these geographical regions. A total of 11,547 persons with HCC were examined. Hawaii had the highest age-adjusted incidence rate (4.6), followed by San Francisco-Oakland (3.2), New Mexico (2.0), Detroit-Metropolitan (1.9), Seattle-Puget Sound (1.8), Atlanta-Metropolitan (1.7), Connecticut (1.6), Iowa (1.1), and Utah (1.0); all rates per 100,000. Whites had an age-adjusted incidence rate of 1.5, Blacks 3.2, and other races "Asian, American Indian, Pacific Islander" 7.0. However, Blacks and "other races" in Seattle-Puget Sound had higher age-adjusted incidence rates (4.4 and 8.2, respectively) than Blacks and other races in any other registry, while Whites in Hawaii had a higher rate (2.5) than Whites in any other registry. In general, men had a two to three times higher age-adjusted incidence rate than women. However, Hawaiian men had significantly higher age-adjusted rates (7.0) than men in other regions, while Utah had the lowest rates of HCC in men (1.5). Adjusting for variations in ethnicity, gender, age, and time of diagnosis, the Poisson regression analysis showed persistent geographic differences in HCC as well as a change in the order with New Mexico having the highest HCC incidence followed San Francisco-Oakland. Hierarchical linear modeling confirmed geographic variations in HCC but failed to show a significant effect for the prevalence of smoking, alcohol use, obesity, and diabetes in the underlying population. Significant geographic variation in HCC incidence exist in the United States. These variations are only partly explained by differences in age, gender, race, and year of diagnosis. (C) 2003 Elsevier Inc. All rights reserved.