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Diabetes Increases Risk of Hepatocellular Carcinoma in All Racial/Ethnic Groups

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Key Points

  • Diabetes at baseline was associated with significantly increased risk of hepatocellular carcinoma among Latinos, Hawaiians, Japanese, and African Americans.
  • It was estimated that 27% of cases in Latinos, 18% in Hawaiians, 13% in African Americans, 12% in Japanese, and 6% in whites were attributable to diabetes.

In a study in the Multiethnic Cohort (composed of men and women from California and Hawaii) reported in the Journal of the National Cancer Institute, Setiawan et al found that diabetes was associated with increased risk of hepatocellular carcinoma in all racial/ethnic groups, with risk being highest in Latinos. 

Risk of Hepatocellular Carcinoma

The study involved analysis of the association of diabetes with hepatocellular carcinoma among 168,679 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in the Multiethnic Cohort. During a median 15.7 years of follow-up, there were 470 incident hepatocellular carcinoma cases.

The highest incidence per 100,000 population was in Latinos (22.5), followed by Native Hawaiians (21.3), Japanese Americans (16.8), African Americans (16.6), and whites (7.5). Compared with whites, age-adjusted hazard rate ratios (RRs) for hepatocellular carcinoma were 2.73 (95% confidence interval [CI] = 2.00–3.72) for Latinos, 2.48 (95% CI = 1.59–3.87) for Native Hawaiians, 2.16 (95% CI = 1.52–3.07) for African Americans, and 2.05 (95% CI = 1.50–2.81) for Japanese.

Effect of Diabetes

Diabetes at baseline was associated with significantly increased risk of hepatocellular carcinoma among Latinos (RR = 3.36, 95% CI = 2.41–4.70), Hawaiians RR = 2.50, 95% CI = 1.11–5.64), Japanese (RR = 2.34, 95% CI = 1.60–3.41), and African Americans (RR = 2.02, 95% CI = 1.17–3.48), with the RR being 2.15 (95% CI = 0.95–4.90) in whites. No heterogeneity was observed across groups (P = .36). Among all groups, the RR was 2.62 (95% CI = 2.13–3.23).

It was estimated that 27% of hepatocellular carcinoma cases in Latinos, 18% in Hawaiians, 13% in African Americans, 12% in Japanese, and 6% in whites were attributable to diabetes.

The investigators concluded: “Latinos were at the highest risk of developing [hepatocellular carcinoma], followed by Native Hawaiians, African Americans, Japanese, and whites. Diabetes is a risk factor for [hepatocellular carcinoma] in all ethnic groups, and eliminating diabetes could potentially reduce [hepatocellular carcinoma] incidence in all ethnic groups, with the largest potential for reduction in Latinos.”

Veronica Wendy Setiawan, PhD, of Keck School of Medicine, University of Southern California, is the corresponding author for the Journal of the National Cancer Institute article.

The study was supported by National Cancer Institute grants.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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