The association between etiology of hepatocellular carcinoma and race-ethnicity in Florida

Paulo S. Pinheiro, Heidy N. Medina, Karen E. Callahan, Patricia D. Jones, Clyde P. Brown, Sean F. Altekruse, Katherine A. McGlynn, Erin N. Kobetz

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background and Aim: The incidence of hepatocellular carcinoma (HCC) has risen considerably in the US since 1980. The main causes include metabolic disorders (NAFLD, diabetes, obesity, metabolic syndrome), alcohol-related disease (ALD) and hepatitis C and B virus infections (HCV, HBV). Etiology-specific HCC incidence rates by detailed race-ethnicity are needed to improve HCC control and prevention efforts. Methods: All HCC cases diagnosed in Florida during 2014-2015 were linked to statewide hospital discharge data to determine etiology. Age-specific and age-adjusted rates were used to assess the intersection between etiology and detailed racial-ethnicities, including White, African American, Afro-Caribbean, Asian, Cuban, Puerto Rican and Continental Hispanic (Mexican, South and Central American). Results: Of 3666 HCC cases, 2594 matched with discharge data. HCV was the leading cause of HCC among men and women (50% and 43% respectively), followed by metabolic disorders (25% and 37%) and ALD (16% and 9%). Puerto Rican and African American men had the highest HCV-HCC rates, 7.9 and 6.3 per 100 000 respectively. Age-specific rates for HCV-HCC peaked among baby boomers (those born in 1945-1965). Metabolic-HCC rates were highest among populations above age 70 and among Continental Hispanics. Afro-Caribbean men had high rates of HBV-HCC, whereas Puerto Rican men had high ALD-HCC. Conclusions: HCC etiology is associated with specific race/ethnicity. While HCV-related HCC rates are projected to decrease soon, HCC will continue to affect Hispanics disproportionately, based on higher rates of metabolic-HCC (and ALD-HCC) among Continental Hispanics, who demographically represent 80% of all US Hispanics. Multifaceted approaches for HCC control and prevention are needed.

Original languageEnglish (US)
Pages (from-to)1201-1210
Number of pages10
JournalLiver International
Issue number5
StatePublished - May 1 2020


  • African American
  • Caribbean
  • Cuban
  • Florida
  • HBV
  • HCV
  • Puerto Rican
  • alcohol-liver disease
  • cause
  • ethnicity
  • etiology
  • hepatocellular carcinoma
  • incidence
  • race
  • subgroup

ASJC Scopus subject areas

  • Hepatology


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