Racial Differences in Liver Cancer Incidence and Risk Factors Among a Low Socioeconomic Population

Background: Liver cancer incidence in the United States is higher among African Americans compared to Whites. The purpose of this study was to examine differences in risk factors associated with Hepatocellular carcinoma (HCC) among Whites and African Americans from low socioeconomic backgrounds in the Southern Community Cohort Study (SCCS). Methods: The SCCS is a prospective cohort study with participants from the southeastern US. HCC incidence rates were calculated. Multivariable Cox regression was used to calculate HCC adjusted hazard ratios (aHR) associated with known baseline HCC risk factors for Whites and African Americans, separately. Results: There were 294 incident HCC. The incidence rate ratio for HCCwas higher (IRR=1.4, 95%CI: 1.1-1.9) in African Americans compared to Whites. Whites saw a stronger association between self-reported Hepatitis C Virus (aHR= 19.24, 95%CI: 10.58-35.00) and diabetes (aHR= 3.55, 95%CI: 1.96-6.43) for the development of HCCcompared to African Americans (aHR= 7.73, 95%CI: 5.71-10.47 and aHR = 1.48, 95%CI: 1.06-2.06, respectively) even though the prevalence of these risk factors was similar between races. Smoking (aHR= 2.91, 95%CI: 1.87-4.52) and heavy alcohol consumption (aHR= 1.59, 95%CI: 1.19-2.11) were significantly associated with HCC risk among African Americans only. Conclusions: In this large prospective cohort, we observed racial differences in HCC incidence and risk factors associated with HCC among African Americans and Whites. Impact: Understanding HCC risk differences can assist prevention strategies that target people at high risk, potentially based on risk factors that differ by race.