Incidence of Primary Liver Cancer in American Indians and Alaska Natives, U.S., 1999–2009

Authors:

Stephanie Melkonian (Presenter)
CDC

Melissa Jim, CDC
Donald Haverkamp, CDC
Brigg Reilley, Indian Health Service
Jennifer Erdrich, Cedars-Sinai Medical Center
Zahava Berkowitz, CDC
Charles Wiggins, University of New Mexico, New Mexico Tumor Registry
Mary White, CDC

Public Health Statement: Incidence of primary liver cancer in the U.S. disproportionately impacts American Indian and Alaska Native (AI/AN) populations. National estimates may not adequately characterize regional differences in these rates.

Purpose: To provide a comprehensive evaluation of liver cancer incidence rates in AI/AN populations for the years 1999–2009.

Methods/Approach: We linked population-based cancer registry data with the Indian Health Service (IHS) patient registration databases to describe liver cancer incidence in non-Hispanic AI/AN persons compared to non-Hispanic whites (Whites) in the U.S. Age-adjusted liver cancer incidence rates are expressed per 100,000. Annual percent changes (APCs) and trends were estimated using joinpoint regression analyses. Rates were assessed for 6 geographic regions and for all regions combined.

Results: AI/AN persons had higher incidence rates of primary liver cancer when compared to Whites overall (11.5 for AI/AN versus 4.8 for Whites) and across all regions. AI/AN rates varied by region. For men, rates ranged from 10.3 (95% CI 7.2–14.3) in the East to 20.4 (95% CI: 17.6–23.5) in the Pacific Coast. For women, rates varied from 5.8 (95% CI: 3.5–8.9) in the East to 8.1 in the Northern Plains (95% CI: 6.1–10.5) and the Southwest (95% CI: 6.8–9.6). We observed a statistically significant increasing trend among AI/AN persons.

Conclusions/Implications: Study findings demonstrate large disparities in liver cancer incidence rates between AI/AN and White populations. Further examination of regional differences in incidence rates could highlight opportunities to reduce the prevalence of important liver cancer risk factors and improve access to preventive health care.