Immigrants with liver cancer survive longer than their U.S.-born counterparts
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Key takeaways:
- About 40% of HCC cases in California’s cancer registry occurred among foreign-born individuals.
- Foreign-born patients had higher 5-year survival rates than U.S.-born patients across major racial, ethnic groups.
Foreign-born patients with hepatocellular carcinoma had higher survival rates than those born in the United States, according to data published in JNCI: Journal of the National Cancer Institute.
Researchers observed the disparity in 5-year survival among foreign- vs. U.S.-born patients across the four major racial and ethnic groups.
“In the end, we were pleased and delighted with this very fruitful investigation that not only confirmed the immigrants’ advantage in hepatocellular carcinoma survival, but also revealed the varied sociodemographic characteristics and survival outcomes among immigrants by race/ethnicity and region of the world,” Lihua Liu, PhD, associate professor of clinical population and public health sciences at Keck School of Medicine of USC, told Healio. “It highlighted the impact of birthplace on HCC is not limited to incidence but also survival time, which underscores the importance of social determinants of health in cancer experience and outcome.”
Background and methodology
Immigrants make up a notable portion of patients within the United States diagnosed with HCC, and although birthplace has an impact on HCC incidence and risk factors, little research has been done regarding its influence on survival rates after diagnosis, according to study background.
Liu and colleagues identified 51,533 adults with HCC and birthplace data available through the California Cancer Registry between 1988 and 2017. The researchers categorized cases as either foreign-born or U.S.-born and logged mutually exclusive race and ethnicity groups.
All-cause mortality served as the primary outcome.
Results
Researchers identified 39.6% of patients with HCC as foreign-born. Foreign-born individuals comprised 92.2% of Asian/Pacific Islander, 45.2% of Hispanic, 9.1% of white and 5.8% of Black patients.
Among the four ethnic groups, 5-year survival rates appeared higher among foreign-born patients when compared with U.S.-born patients: white, 12.9% vs. 9.6%; Hispanic, 11.7% vs. 9.8%; Black, 12.8% vs. 8.1%; and Asian/Pacific Islander, 16.4% vs. 12.4%.
Results showed an association of nativity with improved survival rates among foreign-born patients who identified as white (HR = 0.86; 95% CI, 0.81-0.9), Hispanic (HR = 0.9; 95% CI, 0.86-0.93), Black (HR = 0.89; 95% CI, 0.76-1.05) and Asian/Pacific Islander (HR = 0.94; 95% CI, 0.88-1).
Among foreign-born patients, researchers observed a lower mortality rate among those from Central and South American vs. Mexico for Hispanic individuals, East Asia vs. Southeast Asia for Asian/Pacific Islander individuals, and East Europe/Greater Middle East vs. West/South/North Europe for white individuals.
Next steps
As liver cancer rates continue to rise among those born within the United States, further research is needed to understand why immigrants within the U.S. have better survival outcomes.
“We are exploring the potential collaboration with state or local departments of public health to link the viral hepatitis surveillance data with the cancer registry data to be able to examine the HCC patterns and trends by the different hepatitis types (B or C), as each is associated with different risk factors and behaviors and affects the treatment options and prevention strategies,” Liu told Healio. “We also hope to explore qualitative investigations into the immigrant experience to better understand the underpinnings of this survival advantage, so that we can develop interventions to improve survival for all groups.”
For more information:
Lihua Liu, PhD, can be reached at Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA 90033; email: lihualiu@usc.edu.
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