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Background: Diabetes has been associated with an increa- sed risk of hepatocellular carcinoma (HCC) in studies of referred patients. Th is is the first population based case control study in the USA to examine this a ssociation while adjusting for other major risk factors related to HCC. Methods: We used the Surveillance Epidemiology and End-Results Program (SEER)Medicare l inked database to identify patients aged 65 years and older diagnosed with HCC a nd randomly selected non-cancer controls between 1994 and 1999. Only cases and controls with continuous Medicare enrolment for three years prior to the index d ate were examined. Inpatient and outpatient claims files were searched for diagn ostic codes indicative of diabetes,hepatitis C virus (HCV), hepatitis B virus (H BV), alcoholic liver disease, and haemochromatosis. HCC patients without these c onditions were categorised as idiopathic. Unadjusted and adjusted odds ratios we re calculated in logistic regression analyses. Results: We identified 2061 HCC p atients and 6183 non-cancer controls. Compared with non-cancer controls, patie nts with HCC were male (66%v 36%) and non-White (34%v 18%). The proportion of HCC patients with diabetes (43%) was significantly greater than non-cancer controls (19%). In multiple logistic regression analyses that adjusted for demo graphics features and other HCC risk factors (HCV, HBV, alcoholic liver disease, and haemochromatosis),diabetes was associated with a threefold increase in the risk of HCC. In a subset of patients without these major risk factors, the adjus ted odds ratio for diabetes declined but remained significant (adjusted odds rat io 2.87 (95%con-fidence interval 2.49-3.30)). A significant positive interact ion between HCV and diabetes was detected (p< 0.0001). Similar findings persiste d in analyses restricted to diabetes recorded between two and three years prior to HCC diagnosis. Conclusions:Diabetes is associated with a 2-3-fold increase in the risk of HCC, regardless of the presence of other major HCC risk factors. Findings from this population based study suggest that diabetes is an independen t risk factor for HCC.
Background: Diabetes has been associated with an increa- sed risk of hepatocellular carcinoma (HCC) in studies of referred patients. Th is is the first population based case control study in the USA to examine this a ssociation while adjusting for other major risk factors related to HCC. Methods: We used the Surveillance Epidemiology and End-Results Program (SEER) Medicare l inked database to identify patients aged 65 years and older diagnosed with HCC a randomly selected non-cancer controls between 1994 and 1999. Only cases and controls with continuous Medicare enrolment for three years prior to the index d ate were examined. Inpatient and outpatient claims files were searched for diagnostic codes indicative of diabetes, hepatitis C virus (HCV), hepatitis B virus (H BV), alcoholic liver disease, and haemochromatosis. HCC patients without these c onditions were categorized as idiopathic. Unadjusted and adjusted odds ratios we re calculated in logistic regression analyzes. Results: We Compared with non-cancer controls, patients with HCC were male (66% v 36%) and non-White controls (34% v 18%). The proportion of HCC patients with In multiple logistic regression analyzes that adjusted for demo graphics features and other HCC risk factors (HCV, HBV, alcoholic liver disease, and haemochromatosis), diabetes was associated (19%) was significantly greater than non-cancer controls with a threefold increase in the risk of HCC. In a subset of patients without these major risk factors, the adjus ted odds ratio for diabetes declined but remained significant (adjusted odds rat io 2.87 (95% con-fidence interval 2.49-3.30)) . A significant positive interaction between between HCV and diabetes was detected (p <0.0001). Similar findings persiste d in analyzes restricted to diabetes recorded between two and three years prior to HCC diagnosis. Conclusions: Diabetes is associated with a 2-3-fold increase in the risk of HCC, regardless of the presence of other major HCC risk factors. Findings from this population based study suggest that diabetes is an independen t risk factor for HCC.