Risk Factors for Primary Hepatocellular Carcinoma in Black and White Americans in 2000

Background & Aims: The incidence of primary hepatocellular carcinoma (HCC) is greater in black Americans compared with white Americans. The aim of this study was to better define racial disparity in HCC patients in the United States. Methods: We compared HCC risk factors in 158 black and 701 white HCC patients ≥11 years of age in the Nationwide Inpatient Sample for 2000. Results: Black HCC patients were younger than white patients (mean age, 54.1 ± 17.1 vs. 65.1 ± 13.7 y; P < .002). Sixty-two percent of black HCC patients were age 60 or younger, whereas 68% of white HCC patients were age 61 or older. Hepatitis C virus (HCV) (25.4%), diabetes (22.1%), alcohol (15.1%), cryptogenic cirrhosis (8.6%), and hepatitis B virus (HBV) (7.3%) were the most prevalent risk factors for HCC overall. HBV (22.8% vs 3.9%, P < .0001; adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 3.0-9.2), HCV (34.8% vs 23.3%, P = .0003; OR, 1.3; 95% CI .9-1.9), concurrent HBV and HCV (8.2% vs 1.7%, P < .0001; OR, 4.5; 95% CI, 1.9-10.4), HBV plus diabetes (2.5% vs .3%, P = .002; OR, 14.1; 95% CI, 2.2-88.2), and HCV plus diabetes (8.9% vs 4.4%, P < .02; OR, 2.3; 95% CI, 1.2-4.6) were more common in black HCC patients. There was no racial difference in the frequency of alcoholic and cryptogenic liver diseases and diabetes. Conclusions: Higher rates of HBV, HCV, concurrent HBV and HCV, and viral hepatitis associated with diabetes might explain the greater burden of HCC in black Americans.