Abstract B80: Multiple Risk Factors for Hepatocellular Carcinoma (HCC) among Asian Americans: Implications for Intervention
Authors: Stewart Susan L. , Dang Julie HT , Chen Moon S. 
Published: March 2017

Multiple Risk Factors for Hepatocellular Carcinoma (HCC) among Asian Americans: Implications for Intervention

Introduction: Asian Americans have the highest mortality rates from HCC compared to all other racial/ethnic populations. Historically, mitigating their HCC risks has been through screening for hepatitis B (HBV) and providing linkage to care to those who are chronically infected; however, HCC has multiple risk factors. Besides HBV, obesity-related metabolic factors, including diabetes, and chronic hepatitis C (HCV) are becoming important risk factors for HCC. Lifestyle factors, such as alcohol and tobacco use, also increase risk of HCC. Our study is among the first to measure seven literature-documented HCC risk factors to assess the prevalence of combined risk factors in this population.

Objectives and hypothesis: We sought to measure the joint prevalence of 7 HCC risk factors in 3 domains (viral, metabolic, and lifestyle), and hypothesized that a substantial proportion of foreign-born Asian Americans are at risk in multiple domains.

Methods: We focused on Asians born in HBV endemic areas (≥ 2%) and tested 967 adult foreign-born Chinese, Hmong, Korean, and Vietnamese American residents of Sacramento County, CA for HBV and HCV; measured hemoglobin A1c (HbA1c) and waist circumference; and recorded self-reported history of diabetes, hypertension, consumption of alcohol in the past 30 days, and smoking status. Metabolic risk factors included high glucose, defined as HbA1c ≥ 5.7% or self-reported diagnosis of diabetes; a large waist circumference, defined according to Asian cut-points (≥ 35 inches for men, ≥ 32 inches for women); and self-reported hypertension. We computed gender-specific age standardized prevalence rates with 95% confidence intervals (CI) for viral, metabolic, and lifestyle risk factors, alone and in combination.

Results: Chronic HBV was much more common than HCV in Chinese, Hmong, and Vietnamese Americans; both HBV and HCV were very uncommon among Koreans. Vietnamese men (15.3%, 95% CI 6.9-23.7%) and Hmong women (15.0%, 95% CI 7.6%-22.3%) had the highest viral risk factor prevalence. High glucose was most common among Chinese men (56.3%, 95% CI 43.2-69.3%), followed by Korean men (49.3%, 95% CI 33.4-65.3%). A large waist circumference was most common among Hmong women (83.9%, 95% CI 75.0-92.8%) and Hmong men (66.9%, 95% CI 54.7-79.1%) and least common among Korean men (36.0% 95% CI 19.7-53.2%), Korean women (40.5%, 95% CI 31.3-49.8%), and Vietnamese men (41.8%, 95% CI 30.0-53.7%). Hmong women had the highest prevalence of hypertension (26.8%, 95% CI 18.2-35.4%), and Vietnamese men had the lowest (12.9%, 95% CI 2.7-23.1%). Hmong women had the highest prevalence of at least one metabolic risk factor (85.8%, 95% CI 78.2-93.5%), followed by Hmong men (79.5%, 95% CI 69.6-89.5%), with Korean women having the lowest (54.0%, 95% CI 46.1-62.0%). Among men, smoking was most common among Chinese (28.1%, 95% CI 15.8-40.4%) and least common among Koreans (16.6%, 95% CI 3.4%-29.8%); Vietnamese men were most likely (75.5%, 95% CI 65.6-85.3%) and Hmong least likely (27.4%, 95% CI 16.4-38.4%) to consume alcohol. Among women, smoking was very uncommon in all ethnic groups; alcohol consumption was most common among Vietnamese women (19.0%, 95% CI 11.1-26.9%) and least common among Hmong (5.8%, 95% CI 0.5-11.1%). Vietnamese men were the most likely to have risk factors in two or more domains (59.5%, 95% CI 47.0%-71.9%), followed by Hmong men (43.4%, 95% CI 30.9-55.9%), Chinese men (41.6%, 95% CI 28.2-55.1%), Korean men (31.6%, 95% CI 15.1-48.0%), Vietnamese women (19.9%, 95% CI 11.9-27.8%), Hmong women (19.4%, 95% CI 11.6-27.1%), Chinese women (13.6%, 95% CI 4.4-22.85), and Korean women (11.3%, 95% CI 3.3-19.4%).

Conclusion: Considerable ethnic variation in the prevalence of viral, metabolic, and lifestyle risk factors exists. Efforts to reduce HCC need to concurrently address multiple risk factors.

Citation Format: Susan L. Stewart, Julie HT Dang, Moon S. Chen, Jr. Multiple Risk Factors for Hepatocellular Carcinoma (HCC) among Asian Americans: Implications for Intervention. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B80.