title: Combined effect of socioeconomic status, viral hepatitis, and lifestyles on hepatocelluar carcinoma risk in Korea.
abstract: BACKGROUND
  The independent and combined effects of socioeconomic status (SES), viral hepatitis, and other lifestyle factors on hepatocellular carcinoma (HCC) risk have not been investigated among Koreans.
  
  
  METHODS
  From the National Cancer Center Hospital, 207 HCC cases and 828 age- and gender-matched controls aged 30 years or older were recruited. Socio-demographic and behavioural risk factors were ascertained through personal interview, and infection with hepatitis B and C viruses was determined by their serologic markers. Multivariate logistic regression and synergy index methods were applied for statistical analysis.
  
  
  RESULTS
  HB surface antigen (HbsAg) and anti-HCV-positive rates were 149.3 and 185.1 times higher in cases than controls, respectively. Lifetime alcohol consumption (odds ratio: 2.96, 95% CI: 1.29-6.79), cigarette smoking (OR: 3.53, 95% CI: 1.31-9.52), and family income (OR: 17.07, 95% CI: 4.27-68.25) were independently associated with the risk of HCC in subjects with or without viral hepatitis. Synergistic interaction on HCC risk was observed between low income and HBsAg positivity (SI: 3.12, 95% CI: 1.51-6.47) and between low income and heavy alcohol intake (SI: 2.93, 95% CI: 1.24-6.89).
  
  
  CONCLUSIONS
  The inverse association with SES suggests SES as an independent and synergistic predictor of HCC. Heavy alcohol intake also showed a combined effect with low SES on HCC risk.
authors.affiliation: Branch of Cancer Risk Appraisal & Prevention, National Cancer Information Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyangsi, Gyeonggi-do 410-769, Republic of Korea.
authors.forename: E H
authors.initials: EH
authors.lastname: Yun
authors.forename: M K
authors.initials: MK
authors.lastname: Lim
authors.forename: J-K
authors.initials: JK
authors.lastname: Oh
authors.forename: J H
authors.initials: JH
authors.lastname: Park
authors.forename: A
authors.initials: A
authors.lastname: Shin
authors.forename: J
authors.initials: J
authors.lastname: Sung
authors.forename: E-C
authors.initials: EC
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008019:Life Style; D008113:Liver Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012907:Smoking / Q000009:adverse effects; D012923:Social Class