Associations of race and ethnicity with hepatocellular carcinoma, decompensation, and mortality in US Veterans with cirrhosis

Abstract

Background: Among cirrhosis patients, it remains unclear whether there are racial/ethnic differences in cirrhosis complications and mortality. We examined the associations between race/ethnicity and risk for hepatocellular carcinoma (HCC), cirrhosis decompensation, and all-cause mortality overall and by cirrhosis etiology. Methods: US Veterans diagnosed with cirrhosis from 2001-2014 (n=120,992), due to hepatitis C virus (HCV) (n=55,814), alcohol-associated liver disease (ALD) (n=36,323), hepatitis B virus (HBV) (n=1,972), nonalcoholic fatty liver disease (NAFLD) (n=17,789), or other (n=9,094), were followed through 2020 for incident HCC (n=10,242), cirrhosis decompensation (n=27,887), and mortality (n=81,441). Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: Compared to non-Hispanic White patients, Hispanic patients had higher risk for HCC overall (aHR 1.32, 95% CI 1.24-1.41) and by cirrhosis etiology, particularly for ALD- (aHR 1.63, 95% CI 1.42-1.87) and NAFLD-cirrhosis (aHR 1.76, 95% CI 1.41-2.20), while non-Hispanic Black patients had lower HCC risk in ALD- (aHR 0.79, 95% CI 0.63-0.98) and NAFLD-cirrhosis (aHR 0.54, 95% CI 0.33-0.89). Asian patients had higher HCC risk (aHR 1.70, 95% CI 1.29-2.23), driven by HCV- and HBV-cirrhosis. Non-Hispanic Black patients had lower risk for cirrhosis decompensation overall (aHR 0.71, 95% CI 0.68-0.74) and by cirrhosis etiology. There was lower risk for mortality among all other racial/ethnic groups compared to non-Hispanic White patients. Conclusions: Race/ethnicity is an important predictor for risk of developing HCC, decompensation, and mortality. Impact: Future research should examine factors underlying these racial/ethnic differences to inform prevention, screening, and treatment for cirrhosis patients.