Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle
Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle
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DOI：
10.1016/j.annepidem.2013.11.006
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发表时间：
2014-02-01
影响因子：
5.6
通讯作者：
McGlynn, Katherine A.
中科院分区：
文献类型：
--
作者：
Major, Jacqueline M.;Sargent, James D.;McGlynn, Katherine A.
目的：肝细胞癌在美国的发病率持续上升。发病率的地理差异暗示了地区因素的潜在贡献，如社区社会经济贫困、零售酒精供应和获得医疗保健的机会。方法：利用美国国立卫生研究院-美国退休人员协会饮食和健康研究，我们前瞻性地检查了地区社会经济差异对肝癌发病率(n=434例)和慢性肝病(CLD)死亡率(n=805例死亡)的影响，并评估了酒精出口密度、医疗保健基础设施、糖尿病、肥胖和健康行为的贡献。结果：在考虑了年龄、性别和种族因素后，区域社会经济贫困与肝癌发病率和CLD死亡率的增加相关(HR，1.48；95%CI，1.03-2.14；HR，2.36；95%CI，1.79-3.11)。在额外考虑了教育程度和健康风险因素后，与肝癌发病率的相关性不再显著；与慢性肝病死亡率的相关性仍然显著(HR，1.78；95%CI，1.34-2.36)。酒精出口密度和健康行为方面的社会经济地位差异对社会经济地位-CLD死亡率关联的解释比例最大，分别为10%和29%。没有观察到与卫生保健基础设施的关联。结论：我们的结果表明基于区域的因素对慢性肝病的影响比肝细胞癌更大。个人危险因素对肝细胞癌的影响最大，但对慢性肝病的死亡率影响不大。由爱思唯尔公司出版。
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 health care.Methods: Using the National Institutes of Health-American Association of Retired Persons 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, health care 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. After additionally accounting for educational attainment and health risk factors, associations for HCC incidence were no longer significant; associations for CLD mortality remained significant (HR, 1.78; 95% CI, 1.34-2.36). Socioeconomic status differences in alcohol outlet density and health behaviors explained the largest proportion of socioeconomic status-CLD mortality association, 10% and 29%, respectively. No associations with health care 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. Published by Elsevier Inc.