The Influence of Residential Segregation, Urbanicity, and Population Density on Hepatocellular Carcinoma Incidence among a Low Socioeconomic Population.

Abstract

Background: Hepatocellular carcinoma (HCC) is becoming a leading cause of cancer-related mortality in the United States, with notable disparities observed among racial and ethnic minorities. The objective of this study is to examine the association between social determinants of health (SDoH) and HCC incidence by race (White and Black individuals) using data from the Southern Community Cohort Study.

Methods: The Southern Community Cohort Study is a prospective cohort study with participants recruited from 2002 to 2009. Incident HCC cases were identified during follow-up. Exposure measures, including residential segregation, social vulnerability, population density, rurality, and poverty, were assessed at baseline. Cox proportional hazards regression models were used to estimate HRs associated with SDoH by race with the adjustment of known HCC risk factors.

Results: Among the 79,367 eligible participants, there were 491 incident HCC cases diagnosed, 378 of whom were in Black individuals. In Black individuals, increased population density and urban residency were associated with an increased risk of HCC, even after adjusting for potential confounders [HR = 1.49; 95% confidence interval (CI), 1.04-2.13; HR = 1.70; 95% CI, 1.20-2.41, respectively]. White individuals living in the least segregated areas (HR = 2.83; 95% CI, 1.39-5.78) and in urban settings (HR = 2.34; 95% CI, 1.17-4.65) had an increased HCC risk, whereas population density was not associated with risk.

Conclusions: We found that individuals residing in urban populations had an increased risk of HCC. These findings underscore the complex interplay of SDoH factors and geographic influences on HCC disparities.

Impact: Our findings highlight the need for targeted interventions and further research to address HCC health inequities.