title: Diabetes and racial/ethnic differences in hepatocellular carcinoma risk: the multiethnic cohort.
abstract: BACKGROUND
  Diabetes is an emerging risk factor for hepatocellular carcinoma (HCC), but prospective data from different ethnic populations are scarce. We examined the association between diabetes and HCC in 168679 African Americans, Native Hawaiians, Japanese Americans, Latinos and whites in the Multiethnic Cohort.
  
  
  METHODS
  During a 15.7-year follow up period, 470 incident HCC cases were identified. Risk factor data were obtained from the baseline questionnaire. Cox regressions were used to calculate hazard rate ratios (RRs) and 95% confidence intervals (CIs) for HCC associated with self-reported diabetes. The population attributable risk percent associated with diabetes was also calculated. All statistical tests were two-sided.
  
  
  RESULTS
  The RRs for developing HCC (vs whites) were 2.73 (95% CI = 2.00 to 3.72) for Latinos, 2.48 (95% CI = 1.59 to 3.87) for Hawaiians, 2.16 (95% CI = 1.52 to 3.07) for African Americans, and 2.05 (95% CI = 1.50 to 2.81) for Japanese. Diabetes was associated with HCC across ethnic groups (RRLatinos = 3.36 [95% CI = 2.41 to 4.70], RRHawaiians = 2.50 [95% CI = 1.11 to 5.64], RRJapanese = 2.34 [95% CI = 1.60 to 3.41], RRwhites = 2.15 [95% CI = 0.95 to 4.90], and RRAfrican Americans = 2.02 [95% CI = 1.17 to 3.48]). We estimated that 27% of HCC cases in Latinos, 18% in Hawaiians, 13% in African Americans, 12% in Japanese, and 6% in whites were attributed to diabetes.
  
  
  CONCLUSIONS
  Latinos were at the highest risk of developing HCC, followed by Native Hawaiians, African Americans, Japanese and whites. Diabetes is a risk factor for HCC in all ethnic groups, and eliminating diabetes could potentially reduce HCC incidence in all ethnic groups, with the largest potential for reduction in Latinos.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL). vsetiawa@usc.edu.
authors.forename: Veronica Wendy
authors.initials: VW
authors.lastname: Setiawan
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
authors.forename: Brenda Y
authors.initials: BY
authors.lastname: Hernandez
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
authors.forename: Shelly C
authors.initials: SC
authors.lastname: Lu
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Stram
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
authors.forename: Lynne R
authors.initials: LR
authors.lastname: Wilkens
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
authors.forename: Loic
authors.initials: L
authors.lastname: Le Marchand
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
authors.forename: Brian E
authors.initials: BE
authors.lastname: Henderson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D006528:Carcinoma, Hepatocellular / Q000208:ethnology*; D015897:Comorbidity; D048909:Diabetes Complications / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data*; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D044465:White People / Q000706:statistics & numerical data*