High frequency of chronic end-stage liver disease and hepatocellular carcinoma in a Hispanic population

Background: Texas has the highest mortality from hepatocellular carcinoma in the USA. Because end-stage liver disease mortality is most marked in the Hispanic population in the Lower Rio Grande Valley, the aim of the present paper was to estimate the prevalence of end-stage liver disease and associated factors in Brownsville. Methods: A cross-sectional study was carried out, abstracting medical charts in a community-based clinic and a hospital. A matched case-control analysis was performed. Cases had an International Classification of Disease (9th revision; ICD9) code 155.0 or 571.0-9 (primary liver cancer or chronic liver disease) recorded; age- and sex-matched controls did not have these codes. A total of 176 cases and 352 controls was collected. The main outcome measure was the prevalence and risk factors for end-stage liver disease. Results: Conservative prevalence of end-stage liver disease: 126/100 000 (386/100 000, male). Eleven out of 176 had hepatocellular carcinoma. Median age was 57 years; 72% male, 94% Hispanic. Among significant risk factors were history of hepatitis (odds ratio (OR): 19.3; 95% confidence interval (CI): 8.0-46.4), any history of alcohol use (OR: 6.6; 95%CI: 4-10.8) and history of illegal drug use (OR: 1.9; 95%CI: 1.2-2.9). Fifteen cases with no known risk factors were classified as cryptogenic cirrhosis. Only four cases out of 176 had been referred for liver transplant. Conclusions: The prevalence of end-stage liver disease in the Lower Rio Grande Valley is extremely high, with no single satisfactory explanation and with acute health disparities. Careful follow up of cryptogenic cirrhosis in this population may or may not lead to a new source of liver disease. (C) 2004 Blackwell Publishing Asia Pty Ltd.