title: Hepatitis C virus infection, age, and Hispanic ethnicity increase mortality from liver cancer in the United States.
abstract: OBJECTIVE
  We performed a population-based study to assess factors that are associated independently with hepatocellular carcinoma (HCC)-related mortality.
  
  
  METHODS
  We evaluated clinicodemographic, laboratory, and mortality data collected from 15,866 individuals in the Third National Health and Nutrition Examination Survey from 1988 to 1994. The etiology of chronic liver disease was determined using serologic tests to measure hepatitis C virus (HCV) RNA, hepatitis B surface antigen, and iron; excessive alcohol consumption and nonalcoholic fatty liver disease (NAFLD) were determined. Cohorts were compared with controls using a stratum-specific chi-square test. The Cox proportional hazard model was used to identify independent predictors of HCC-related mortality.
  
  
  RESULTS
  After a follow-up period of 160 months, 14.55% of the individuals died; 83 deaths were liver-related (25 HCC and 58 non-HCC liver related). Factors that independently predicted HCC-related mortality were age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.04-1.16; P = .0021), Hispanic ethnicity (HR, 5.14; 95% CI, 1.75-15.06; P = .0036), and HCV infection (HR, 18.12; 95% CI, 3.57-91.98; P = .0008). Factors that independently predicted non-HCC liver-related mortality included age (HR, 1.07; 95% CI, 1.04-1.10; P < .0001), male sex (HR, 3.29; 95% CI, 1.15-9.42; P = .0277), alcoholic liver disease (HR, 10.81; 95% CI, 1.32-88.26; P = .0271), HCV (HR, 27.00; 95% CI, 4.70-155.1; P = .0004), iron overload (HR, 6.18; 95% CI, 1.82-20.97; P = .0043), or NAFLD (HR, 11.56; 95% CI, 3.21-41.67; P = .0004).
  
  
  CONCLUSIONS
  This population-based study showed that HCV infection and Hispanic ethnicity independently increase the risk for HCC-related mortality. All liver diseases, including NAFLD, increase the risk for non-HCC liver-related mortality.
authors.affiliation: Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, Virginia 22042, USA. zobair.younossi@inova.org
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005234:Fatty Liver / Q000150:complications; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications*; D006630:Hispanic or Latino; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult