title: Impact of country of birth on age at the time of diagnosis of hepatocellular carcinoma in the United States.
abstract: BACKGROUND
  There is global variation in the onset of hepatocellular carcinoma (HCC). The objective of the current study was to investigate the impact of country of birth on age at the time of HCC diagnosis in the United States.
  
  
  METHODS
  Incident HCC cases diagnosed between 2000 and 2012 in the Surveillance, Epidemiology, and End Results program 18 registry were included. Factors associated with very early onset (age at diagnosis < 40 years) and early onset (age at diagnosis < 50 years) were identified by logistic regression.
  
  
  RESULTS
  A total of 59,907 patients were included. The median age at the time of diagnosis of HCC was 62 years and 76% of the patients were male. Of the 75% of patients for whom information regarding birth country was available, 29% were foreign born. In multivariate logistic regression, birth in West Africa (adjusted odds ratio [AOR], 16.3; 95% confidence interval [95% CI], 9.2-27.9 [P<.01]), Central/South/other Africa (AOR, 11.0; 95% CI, 4.5-23.7 [P<.01]), Oceania (AOR, 4.9; 95% CI, 2.9-8.0 [P<.01]), and East Africa (AOR, 3.5; 95% CI, 1.5-6.8 [P<.01]) was found to have the strongest association with very early-onset HCC after adjusting for sex and race/ethnicity. Birth in West Africa, Central/South/other Africa, Oceania, or East Africa also was found to be strongly associated with early-onset HCC.
  
  
  CONCLUSIONS
  Birth country was found to be independently associated with age at the time of HCC diagnosis in the United States. Birth in Africa (except for North Africa) and Oceania was strongly associated with very early-onset HCC. These findings have implications for the design of comprehensive HCC surveillance programs in the United States. Cancer 2016. © 2016 American Cancer Society. Cancer 2017;81-89. © 2016 American Cancer Society.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Ju Dong
authors: JD
authors: Yang
authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
authors: Sean F
authors: SF
authors: Altekruse
authors: Division of Gastroenterology and Hepatology, Stanford Cancer Institute, Stanford University, Palo Alto, California.|Center for Innovation in Global Health, Stanford University Medical Center, Palo Alto, California.
authors: Mindie H
authors: MH
authors: Nguyen
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Gregory J
authors: GJ
authors: Gores
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Lewis R
authors: LR
authors: Roberts
mesh_terms: D000328:Adult; D000349:Africa; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D036801:Parturition / Q000502:physiology; D044469:Racial Groups; D012042:Registries; D012307:Risk Factors; D018426:SEER Program; D014481:United States
keywords: Africa; Oceania; age; early onset; liver cancer