Abstract
Liver cancer is the fastest increasing cancer in the United States and is one of the leading causes of cancer-related death in New York City (NYC), with wide disparities among neighborhoods. The purpose of this cross-sectional study was to describe liver cancer incidence by neighborhood and examine its association with risk factors. This information can inform preventive and treatment interventions. Publicly available data were collected on adult NYC residents (n = 6,407,022). Age-adjusted data on liver and intrahepatic bile duct cancer came from the New York State Cancer Registry (1) (2007-2011 average annual incidence); and the NYC Vital Statistics Bureau (2015, mortality). Data on liver cancer risk factors (2012-2015) were sourced from the New York City Department of Health and Mental Hygiene: (1) Community Health Survey, (2) A1C registry, and (3) NYC Health Department Hepatitis surveillance data. They included prevalence of obesity, diabetes, diabetic control, alcohol-related hospitalizations or emergency department visits, hepatitis B and C rates, hepatitis B vaccine coverage, and injecting drug use. Liver cancer incidence in NYC was strongly associated with neighborhood poverty after adjusting for race/ethnicity (β = 0.0217, p = 0.013); and with infection risk scores (β = 0.0389, 95% CI = 0.0088-0.069, p = 0.011), particularly in the poorest neighborhoods (β = 0.1207, 95% CI = 0.0147-0.2267, p = 0.026). Some neighborhoods with high hepatitis rates do not have a proportionate number of hepatitis prevention services. High liver cancer incidence is strongly associated with infection risk factors in NYC. There are gaps in hepatitis prevention services like syringe exchange and vaccination that should be addressed. The role of alcohol and metabolic risk factors on liver cancer in NYC warrants further study.
Highlights
Cancer of the liver and intrahepatic bile ducts is a public health problem in the United States (US)
No guidelines currently exist for routine liver cancer screening in people of average risk; people at higher risk due to cirrhosis and/ or chronic hepatitis B infection may benefit from screening with ultrasound exams, with or without alpha-fetoprotein blood tests, twice a year [5]
To understand the basis for New York City (NYC) disparities in liver cancer incidence and mortality, it is crucial to identify high-risk subpopulations, the risk factors most strongly associated with liver cancer, and how they are distributed in the city
Summary
Cancer of the liver and intrahepatic bile ducts (liver cancer) is a public health problem in the United States (US). The 5-year survival rate for regional and distant liver cancer is even poorer at 11 and 3%, respectively [2]. In New York City (NYC), liver cancer is the fifth leading cause of cancer-related death among men and seventh among women [1]. The 2010–2014 age-adjusted liver cancer incidence rate in NYC was 12 per 100,000 residents, higher than the US (7.8) and New York State (NYS) (8.6) [1, 6]. The age-adjusted mortality rate per 100,000 was higher at 7.7 compared with the US (6.3) and NYS (6.1) [1, 6]. To understand the basis for NYC disparities in liver cancer incidence and mortality, it is crucial to identify high-risk subpopulations, the risk factors most strongly associated with liver cancer, and how they are distributed in the city. The information can help inform preventive and treatment interventions for communities that require them the most
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