Review
Chronic Liver Disease in the Hispanic Population of the United States

https://doi.org/10.1016/j.cgh.2011.04.027Get rights and content

Chronic liver disease is a major cause of morbidity and mortality among Hispanic people living in the United States. Environmental, genetic, and behavioral factors, as well as socioeconomic and health care disparities among this ethnic group have emerged as important public health concerns. We review the epidemiology, natural history, and response to therapy of chronic liver disease in Hispanic patients. The review covers nonalcoholic fatty liver disease, viral hepatitis B and C, coinfection of viral hepatitis with human immunodeficiency virus, alcoholic cirrhosis, hepatocellular carcinoma, autoimmune hepatitis, and primary biliary cirrhosis. For most of these disorders, the Hispanic population has a higher incidence and more aggressive pattern of disease and overall worse treatment outcomes than in the non-Hispanic white population. Clinicians should be aware of these differences in caring for Hispanic patients with chronic liver disease.

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Methods

We searched the MedLine database to identify relevant studies. The Medical Subject Heading terms “Hispanic American” (which encompasses Hispanic, Latino, Mexican American, Spanish American, Cuban American, Puerto Rican, and persons from Central or South America, or other Spanish culture or origin), “Ethnic Groups,” and “Population Groups” were combined with the Boolean operator “AND” to the search terms “chronic liver disease,” “cirrhosis,” “nonalcoholic fatty liver disease,” “NAFLD,”

Results

Hispanic people living in the United States exhibit singular variations in epidemiology, natural history, and response to therapy of chronic liver disease. Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in Hispanic persons followed by chronic alcoholic liver disease and viral hepatitis C and B.12, 13, 14, 15 Among Hispanic persons, hepatocellular carcinoma also has a higher incidence and worse prognosis than NHW or African American persons.16, 17 Data on

Conclusions

The major characteristics of chronic liver disease in Hispanic persons are summarized in Table 4. The Hispanic population represents the largest and fastest growing minority group in the United States. Despite an overall relative survival advantage of Hispanic versus NHW patients, liver diseases are an important and disproportionate cause of morbidity and mortality for the Hispanic population in the United States. Data suggest a higher incidence, more aggressive pattern, and overall worse

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      Citation Excerpt :

      Incidence amongst US-born Hispanics seems to be higher than foreign-born Hispanics which have higher incidence of HCV, non-alcoholic fatty liver disease (NAFLD), metabolic syndrome, and alcoholic liver disease [1,5–8]. A role of genetic predisposition (e.g., PNPLA3) has also been postulated as an accelerator to the progression of cirrhosis [5]. The state of Texas reported the highest age-adjusted incidence of HCC, comprising one-fifth of all reported cases diagnosed in the United States from 2000 to 2012 [3].

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    This article has an accompanying continuing medical education activity on page e109. Learning Objectives—At the end of this activity, the learner will recognize the spectrum of liver disease in the Hispanic population in the United States, appreciate the importance of fatty liver disease and its progression to cirrhosis, and understand the role of viral hepatitis in the genesis of liver disease in the Hispanic US population.

    Conflicts of interest The authors disclose no conflicts.

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