Hepatocellular carcinoma prevalence and mortality in a male state prison population.
OBJECTIVE
The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system.


METHODS
The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system.


RESULTS
During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes.


CONCLUSIONS
Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners.
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. jbaillar@utmb.edu
Jacques
J
Baillargeon
Ned
N
Snyder
Roger D
RD
Soloway
David
D
Paar
Gwen
G
Baillargeon
Anne C
AC
Spaulding
Brad H
BH
Pollock
Christine M
CM
Arcari
Brie A
BA
Williams
Ben G
BG
Raimer
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality*; D006801:Humans; D007256:Information Systems; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D013781:Texas / Q000453:epidemiology; D055815:Young Adult