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Katherine A. McGlynn, PhD, MPH Senior Investigator Division of Cancer Epidemiology and Genetics

Attributable fraction of NAFLD and Related Disorders to Hepatocellular Carcinoma in the United States. Katherine A. McGlynn, PhD, MPH Senior Investigator Division of Cancer Epidemiology and Genetics National Cancer Institute, NIH Bethesda, MD. Disclosure Statement.

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Katherine A. McGlynn, PhD, MPH Senior Investigator Division of Cancer Epidemiology and Genetics

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  1. Attributable fraction of NAFLD and Related Disorders to Hepatocellular Carcinoma in the United States Katherine A. McGlynn, PhD, MPH Senior Investigator Division of Cancer Epidemiology and Genetics National Cancer Institute, NIH Bethesda, MD

  2. Disclosure Statement • I have no financial disclosures or conflicts of interest

  3. Liver Cancer Trends, 1978-2012 (Cancer Incidence in 5 Continents) Age-Adjusted Rate per 100,000 person-years Petrick JL et al., Int J Cancer, In press

  4. Liver Cancer Trends, 1978-2012 (Cancer Incidence in 5 Continents) Age-Adjusted Rate per 100,000 person-years Petrick JL et al., Int J Cancer, In press

  5. Liver Cancer Trends, 1978-2012 (Cancer Incidence in 5 Continents) Age-Adjusted Rate per 100,000 person-years Petrick JL et al., Int J Cancer, In press

  6. HCC incidence rates, SEER-13, 1992-2016 2012

  7. HCC incidence rates, SEER-13, 1992-2016 2012 2012

  8. HCC incidence rates, SEER-13, 1992-2016 9.66 - Hispanic 9.28 - NHB 9.07 - API 4.06 - NHW

  9. HCC incidence rates, SEER-13, 1992-2016 9.66 - Hispanic 9.28 - NHB 9.07 - API 4.06 - NHW

  10. Liver Cancer Incidence in the U.S. by state 7.5 7.6 11.5 8.5 7.5 10.4 8.0 Data Source: CDC WONDER 9.1 10.3 9.4

  11. Risk Factors for HCC Global - US | 9

  12. NAFLD Questions • What is the contribution of NAFLD to HCC incidence? • What is the contribution of NAFLD to mortality?

  13. NAFLD Questions • What is the contribution of NAFLD to HCC incidence? • What is the contribution of NAFLD to mortality?

  14. SEER-Medicare Linked Database Medicare insurance claims Cancer diagnoses

  15. HCC cases and controls in SEER-Medicare analysis

  16. HCC risk factors identified by ICD codes

  17. Odds ratios for HCC risk factors

  18. Odds ratios for HCC risk factors by race-ethnicity

  19. Attributable fractions of HCC risk factors by sex

  20. Attributable fractions of HCC risk factors by race/ethnicity

  21. Attributable fractions of HCC risk factors by year-groups

  22. Summary • The relative risk of metabolic disorders is fairly small compared to other risk factors. • The attributable risk of metabolic disorders is substantial due to their prevalence in the population. • The attributable risk of metabolic disorders appears to be increasing over time.

  23. NAFLD Questions • What is the contribution of NAFLD to HCC incidence? • What is the contribution of NAFLD to mortality?

  24. Prevalence of NAFLD by ultrasonography in the U.S. NHANES III 1988-1994 Follow-up through 2015 21-27 years follow-up

  25. Prevalence of NAFLD by ultrasonography in the U.S. N=14,797 persons aged 20-74 years completed interview and physical exam NHANES III 1988-1994 N=13,856 persons had a useable abdominal ultrasound image N=1,241 persons excluded due to high alcohol consumption N=324 persons excluded due to HBsAg(+) and/or anti-HCV(+) N=28 persons excluded due to iron overload N=10 persons excluded due to lack of follow-up data N=12,253 total analytical sample N=4,355 with NAFLD, N=7,898 without NAFLD Alvarez CS et al, Submitted

  26. Prevalence of NAFLD by ultrasonography in the U.S. NHANES III 1988-1994 Alvarez CS et al, Submitted

  27. Risk of mortality in association with NAFLD NHANES III 1988-1994 Alvarez et al, Submitted

  28. Risk of mortality in association with NAFLD NHANES III 1988-1994 Alvarez CS et al, Submitted Global - US | 9

  29. Risk of mortality in association with NAFLD NHANES III 1988-1994 Global - US | 9

  30. Risk of mortality in association with NAFLD NHANES III 1988-1994 Alvarez CS et al, Submitted

  31. Percent of deaths in the U.S. associated with exposures • Percent of U.S. deaths associated with: • Smoking: 18-26% • Overweight/obesity: 18% • Alcohol: 2-6% Lariscy, JT, et al., Demography 2018;55:1855-85. Masters RK, et al., Am J Pub Health 2013;103:1895-1901. Global Burden of Disease, Lancet 2018;392:1015-1035.

  32. Trends in prevalence of obesity, U.S., NHANES 1999-2016

  33. Acknowledgements Boston University Jessica L. Petrick National Cancer Institute Barry I. Graubard Christian S. Alvarez Andrea A. Florio Timothy S. McNeel David Ruggieri International Agency for Research on Cancer Freddie Bray Ariana Znaor Jacques Ferlay Mathieu Laversanne QIMR Berghofer Medical Research Institute Patricia C. Valery

  34. Odds ratios for HCC risk factors by year-groups

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