Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

• Published in: JGH open 2020-06, Vol.4 (3), p.351-359
• Main Authors: Thylur, Ramesh P, Roy, Sanjit K, Shrivastava, Anju, LaVeist, Thomas A, Shankar, Sharmila, Srivastava, Rakesh K
• Format: Article
• Language: English
• Subjects: Age; Alcohol; alcohol intake; Asian Americans; Cultural differences; Diabetes; Disease prevention; Environmental factors; Epidemiology; ethnic disparities; Ethnicity; Gender; Genetics; Geography; Health care; Health care access; Hepatitis; hepatitis B (HBV) infection; hepatitis C (HCV) infection; hepatocellular carcinoma; Hispanic people; Immunization; Infections; Liver cancer; Liver cirrhosis; Liver diseases; metabolic syndrome; Metabolism; Mortality; Mortality risk; Native North Americans; nonalcoholic fatty liver disease; obesity; Population genetics; Race; Review; Risk assessment; Risk factors; smoking; Womens health
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12336

Despite improved screening and surveillance guidelines, significant race/ethnicity‐specific disparities in hepatocellular carcinoma (HCC) continue to exist and disproportionately affect minority and disadvantaged populations. This trend indicates that social determinants, genetic, and environmental factors are driving the epidemic at the population level. Race and geography had independent associations with risk of mortality among patients with HCC. The present review discusses the risk factors and issues related to disparities in HCC. The underlying etiologies for these disparities are complex and multifactorial. Some of the risk factors for developing HCC include hepatitis B (HBV) and hepatitis C (HCV) viral infection, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, smoking and alcohol consumption. In addition, population genetics; socioeconomic and health care access; treatment and prevention differences; and genetic, behavioral, and biological influences can contribute to HCC. Acculturation of ethnic minorities, insurance status, and access to health care may further contribute to the observed disparities in HCC. By increasing awareness, better modalities for screening and surveillance, improving access to health care, and adapting targeted preventive and therapeutic interventions, disparities in HCC outcomes can be reduced or eliminated. Population genetics, socioeconomic and health care access, treatment and prevention differences, dietary composition, and genetic, behavioral and biological influences can contribute to hepatocellular carcinoma (HCC). Acculturation of ethnic minorities, insurance status and access to healthcare may further contribute to the observed disparities in HCC. By increasing awareness and better modalities for screening and surveillance, targeted preventive and therapeutic interventions for reducing disparities can be successfully improved.