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. 2023 May;21(5):1314-1322.e5.
doi: 10.1016/j.cgh.2022.06.031. Epub 2022 Aug 4.

Neighborhood-Level Factors Contribute to Disparities in Hepatocellular Carcinoma Incidence in Texas

Abiodun O Oluyomi  1 , Hashem B El-Serag  2 , Adegboyega Olayode  3 , Aaron P Thrift  4
Affiliations

Neighborhood-Level Factors Contribute to Disparities in Hepatocellular Carcinoma Incidence in Texas

Abiodun O Oluyomi et al. Clin Gastroenterol Hepatol. 2023 May.

Abstract

Background and aims: Texas has the highest hepatocellular carcinoma (HCC) incidence rates in the continental United States, but these rates vary by race-ethnicity. We examined racial-ethnic disparities through a geospatial analysis of the social determinants of health.

Methods: Using data from the Texas Cancer Registry, we assembled 11,547 HCC cases diagnosed between 2011 and 2015 into Texas's census tracts geographic units. Twenty-nine neighborhood measures representing demographics and socioeconomic, and employment domains were retrieved from the U.S. Census Bureau. We performed a series of aspatial and spatially weighted regression models to identify neighborhood-level characteristics associated with HCC risk.

Results: We found positive associations between HCC and proportion of population in census tracts that are Black or African American, Hispanic, over 60 years of age, in the construction industry, and in the service occupation but an inverse association with the proportion of population employed in the agricultural industry. The magnitude of these associations varied across Texas census tracts.

Conclusions: We found evidence that neighborhood-level factors are differentially associated with variations in HCC incidence across Texas. Our findings reinforce existing knowledge about HCC risk factors and expose others, including neighborhood-level employment status.

Keywords: Disparities; Epidemiology; Liver Cancer; Risk Factors; Social Determinants of Health.

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Conflict of interest statement

Competing interests

None.

Figures

Figure 1.
Figure 1.
The 2011–2015 average annual age-adjusted hepatocellular carcinoma (HCC) incidence rates shown for Texas’ census tracts. * 5,205 of the 5,265 Texas census tracts were included for analysis. ** The natural breaks technique (i.e., Jenks optimization) was used to classify the data; Jenks seeks to minimize intra-class variance and simultaneously maximize inter-class.
Figure 2.
Figure 2.
The local beta coefficients were exponentiated (RR) to show the sensitivity of HCC incidence to a change of 10-unit difference in each of the neighborhood characteristics shown above, specific to each census tract. The class labeled 0.991–1.010 crosses 1.0. To simplify interpretation, colors before yellow shade (from top to bottom) suggest census tracts where an increase in the proportion of a given independent variable was associated with decreased RR for HCC, while colors after the yellow shade suggest census tracts where an increase in the proportion of the explanatory variables was associated with increased RR for HCC.
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