Gastroenterology

Gastroenterology

Volume 127, Issue 5, November 2004, Pages 1372-1380
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: A population-based study

https://doi.org/10.1053/j.gastro.2004.07.020Get rights and content

Background & Aims: A significantincrease in the incidence of hepatocellular carcinoma (HCC) has been reported in the United States. The risk factors underlying this increase remain unclear. Methods: By using Surveillance, Epidemiology, and End-Results program (SEER)-Medicare–linked data, we conducted a population-based study to examine temporal changes in risk factors for patients 65 years and older diagnosed with HCC between 1993 and 1999. Only patients with continuous Medicare enrollment for 2 years before and up to 2 years after HCC diagnosis were examined. Univariate and multiple logistic regression analyses were used to evaluate changes in risk factors over time (January 1993–June 1996 and July 1996–December 1999). Results: The age-adjusted incidence of HCC among persons 65 years of age and older significantly increased from 14.2 per 100,000 in 1993 to 18.1 per 100,000 in 1999. We identified 2584 patients with continuous Medicare enrollment 2 years before and up to 2 years after HCC diagnosis. The proportion of hepatitis C virus (HCV)-related HCC increased from 11% during January of 1993 to June of 1996 to 21% during July of 1996 to December of 1999, whereas hepatitis B virus (HBV)-related HCC increased from 6% to 11% (P < .0001). In multiple logistic regression analyses that adjusted for age, sex, race, and geographic region, the risk for HCV-related HCC and HBV-related HCC increased by 226% and 67%, respectively. Idiopathic HCC decreased from 43% to 39%. This decrease did not fully account for the significant increases observed for HCV and HBV. No significant changes over time were observed for alcohol-induced liver disease, nonspecific cirrhosis, or nonspecific hepatitis. Conclusions: There has been a significant recent increase in HCV- and HBV-related HCC. Increasing rates of HCV-related HCC can explain a substantial proportion of the reported increase in HCC incidence during recent years.

Section snippets

Data source

Data used for this study were obtained from the SEER-Medicare database, which is the linkage of SEER registry information with Medicare claims data. The SEER program is an ongoing contract-supported program of the National Cancer Institute to collect population-based cancer incidence and survival data. Since 1992, the SEER program has collected data on incident cancer cases from 11 population-based cancer registries in 5 states (Connecticut, Hawaii, Iowa, New Mexico, Utah) and 6 metropolitan

Results

We initially identified 4015 patients age 65 years and older in the SEER-Medicare database with diagnostically confirmed HCC between 1993 and 1999. Of these cases, 2584 patients with HCC satisfied our criteria for inclusion in the study cohort. The 1431 patients were excluded for the following reasons: enrollment in a Medicare HMO plan during the 2 years before or after the date of HCC diagnosis (n = 960); enrollment in Medicare part A and part B for less than 2 years before the index date (n =

Discussion

Our study was a population-based study to examine the underlying risk factors among patients with HCC in the United States between 1993 and 1999. Among Medicare-enrolled patients with HCC, significant increases in HCV- and HBV-related HCC occurred over the past decade, whereas HCC associated with alcohol-induced liver disease, nonspecific cirrhosis, and nonspecific hepatitis has remained unchanged. HCV-related HCC doubled from 11% to 21% of all HCCs, whereas HBV-related HCC increased from 6% to

References (24)

  • J.L. Warren et al.

    Overview of the SEER-Medicare datacontent, research applications, and generalizability to the United States elderly population

    Med Care

    (2002)
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