Chronic Liver Disease in the Hispanic Population of the US
Chronic Liver Disease in the Hispanic Population of the US
Chronic liver disease is a major cause of morbidity and mortality among Hispanic people living in the United States. Environmental, genetic, and behavioral factors, as well as socioeconomic and health care disparities among this ethnic group have emerged as important public health concerns. We review the epidemiology, natural history, and response to therapy of chronic liver disease in Hispanic patients. The review covers nonalcoholic fatty liver disease, viral hepatitis B and C, coinfection of viral hepatitis with human immunodeficiency virus, alcoholic cirrhosis, hepatocellular carcinoma, autoimmune hepatitis, and primary biliary cirrhosis. For most of these disorders, the Hispanic population has a higher incidence and more aggressive pattern of disease and overall worse treatment outcomes than in the non-Hispanic white population. Clinicians should be aware of these differences in caring for Hispanic patients with chronic liver disease.
The Hispanic population is the largest and fastest growing minority group in the United States. Currently they comprise 15% of the United States population and by the year 2050 will be 30% of the population. The Census Bureau classifies Hispanic as an ethnic group and considers the terms Hispanic, Latino, and Spanish as synonymous. Hispanic persons can be of any racial background and represent a heterogeneous population with multiple origins, cultures, and genetic backgrounds including people of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. Mexican Americans comprise 65% of the United States Hispanic population, followed by Central and South Americans (17.4%), Puerto Ricans (8.6%, not including the 4.2 million people living on the island of Puerto Rico), and Cuban Americans (4%). Most Hispanic persons now living in the United States were born in the United States and less than one-third of Hispanic persons residing in the United States are immigrants. On average, Hispanic persons living in the United States have a socioeconomic status equivalent to African American people, but mortality rates that are comparable to those of non-Hispanic White (NHW) persons and considerably better than the African American population. Furthermore, life expectancy among Hispanic people is on average 3 years greater than in NHW people. These epidemiologic characteristics of low socioeconomic status but favorable overall health outcomes are commonly referred to as "the Hispanic paradox."
Despite the overall survival advantage for Hispanic persons, they are at increased risk for certain diseases including chronic liver disease. Data from the United States National Center for Health Statistics (2000 –2006) identified chronic liver disease as the sixth most common cause of death in the Hispanic population. In contrast, liver disease is not included among the 10 most frequent causes of mortality in NHW and African American populations. Mortality from chronic liver disease in Hispanic people in the United States is nearly 50% higher than in NHW persons (13.7 per 100,000 in Hispanic persons vs 9.2 in NHW and 7.5 in African American persons. Furthermore, while mortality rates from chronic liver disease in the United States progressively declined during the past decade, this trend was not evident in the Hispanic population. These ethnic differences in liver disease burden remain poorly understood but variations in behavioral patterns, healthcare access, referral to specialists, and utilization of therapeutic interventions have all been proposed as potential explanations for these less favorable outcomes in Hispanic persons.
Abstract and Introduction
Abstract
Chronic liver disease is a major cause of morbidity and mortality among Hispanic people living in the United States. Environmental, genetic, and behavioral factors, as well as socioeconomic and health care disparities among this ethnic group have emerged as important public health concerns. We review the epidemiology, natural history, and response to therapy of chronic liver disease in Hispanic patients. The review covers nonalcoholic fatty liver disease, viral hepatitis B and C, coinfection of viral hepatitis with human immunodeficiency virus, alcoholic cirrhosis, hepatocellular carcinoma, autoimmune hepatitis, and primary biliary cirrhosis. For most of these disorders, the Hispanic population has a higher incidence and more aggressive pattern of disease and overall worse treatment outcomes than in the non-Hispanic white population. Clinicians should be aware of these differences in caring for Hispanic patients with chronic liver disease.
Introduction
The Hispanic population is the largest and fastest growing minority group in the United States. Currently they comprise 15% of the United States population and by the year 2050 will be 30% of the population. The Census Bureau classifies Hispanic as an ethnic group and considers the terms Hispanic, Latino, and Spanish as synonymous. Hispanic persons can be of any racial background and represent a heterogeneous population with multiple origins, cultures, and genetic backgrounds including people of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin. Mexican Americans comprise 65% of the United States Hispanic population, followed by Central and South Americans (17.4%), Puerto Ricans (8.6%, not including the 4.2 million people living on the island of Puerto Rico), and Cuban Americans (4%). Most Hispanic persons now living in the United States were born in the United States and less than one-third of Hispanic persons residing in the United States are immigrants. On average, Hispanic persons living in the United States have a socioeconomic status equivalent to African American people, but mortality rates that are comparable to those of non-Hispanic White (NHW) persons and considerably better than the African American population. Furthermore, life expectancy among Hispanic people is on average 3 years greater than in NHW people. These epidemiologic characteristics of low socioeconomic status but favorable overall health outcomes are commonly referred to as "the Hispanic paradox."
Despite the overall survival advantage for Hispanic persons, they are at increased risk for certain diseases including chronic liver disease. Data from the United States National Center for Health Statistics (2000 –2006) identified chronic liver disease as the sixth most common cause of death in the Hispanic population. In contrast, liver disease is not included among the 10 most frequent causes of mortality in NHW and African American populations. Mortality from chronic liver disease in Hispanic people in the United States is nearly 50% higher than in NHW persons (13.7 per 100,000 in Hispanic persons vs 9.2 in NHW and 7.5 in African American persons. Furthermore, while mortality rates from chronic liver disease in the United States progressively declined during the past decade, this trend was not evident in the Hispanic population. These ethnic differences in liver disease burden remain poorly understood but variations in behavioral patterns, healthcare access, referral to specialists, and utilization of therapeutic interventions have all been proposed as potential explanations for these less favorable outcomes in Hispanic persons.
