Socioeconomic status and hepatocellular carcinoma in the United States.
BACKGROUND
Hepatocellular carcinoma (HCC) has a poor prognosis and, unlike most cancers, HCC incidence and mortality rates are increasing in the United States. While risk is known to vary among different racial and ethnic groups, less is known about the variability of risk within these groups by neighborhood socioeconomic status (SES).


METHODS
HCC cases diagnosed in the Surveillance, Epidemiology and End Results (SEER) 11 cancer registries between 1996 and 2007, and the population of the SEER 11 catchment areas was studied. Analyses were conducted to compare census tract area family poverty, educational attainment, and unemployment by race and ethnicity. A multiple linear regression model, weighted by the number of cases and the number of individuals in each census tract, with adjustment for registry, was used to calculate mean differences in area-level attributes between HCC cases and the population.


RESULTS
HCC cases in most racial/ethnic groups had lower mean neighborhood-level measures of SES than their referent population. An exception was seen among Hispanics. Comparing white cases with cases of other racial groups and to Hispanics, white cases lived in neighborhoods with less family poverty, fewer high-school dropouts, and lower unemployment. Compared with white cases, Asian and Pacific Islander and Hispanic cases lived in neighborhoods with a higher percentage of foreign-born population.


CONCLUSIONS
Low neighborhood-level SES and immigrant status may be associated with greater risk of HCC within specific racial and ethnic groups.


CONCLUSIONS
These findings could help to focus control resources for HCC toward the most affected communities.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20852, USA.
Fatma M
FM
Shebl
David E
DE
Capo-Ramos
Barry I
BI
Graubard
Katherine A
KA
McGlynn
Sean F
SF
Altekruse
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D016022:Case-Control Studies; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012111:Residence Characteristics; D018426:SEER Program; D012923:Social Class; D014478:Unemployment; D014481:United States / Q000453:epidemiology