Hepatocellular cancer: risk factors and survival in Pacific Islanders compared to Caucasians in Hawaii.

BACKGROUND: Hepatocellular cancer (HCC) is increasing in the United States. Although studies indicate that Asian and Pacific Islanders have an especially high incidence, no study has characterized HCC in the subgroup of Pacific Islanders (PI) alone. OBJECTIVE: To describe risk factors/survival of HCC in PI compared to Caucasians in Hawaii. PATIENTS: Of 523 HCC patients referred 1993-2008, 72 PI patients were compared to 85 Caucasian patients. MEASUREMENTS: In this retrospective-cohort study, data collected included demographics, risk factors, tumor characteristics, laboratory studies, treatment and survival. Chi-square analyses and t-tests identified difference between groups. Cox-proportional hazards model determined regression analysis of survival data. RESULTS: Mean age and sex distribution were not significantly different between groups. PI were more likely to have hepatitis B (36% vs 6%, P<.05), symptoms at presentation (60% vs 40%, P=.003), and larger tumors (P=.02). Caucasians were more likely to have hepatitis C (65% vs 43%, P=.01) and encephalopathy. Mean survival was significantly different between PI and Caucasians (10.9 months vs 43.3 months, P=.01). Multivariate-regression analysis showed late stage III/IV, increased Childs score, hepatitis B infection, and alcohol history associated with decreased survival. PI ethnicity was independently associated with increased hazard ratio. Treatment regardless of modality reduced hazard ratio for survival. CONCLUSION: PI with HCC were more likely to have hepatitis B, symptoms and larger tumors, though they were just as likely to have their HCC found upon screening. PI ethnicity independently affected survival. Better education of the community/physicians on detection of hepatitis B and recognizing this risk for HCC in PI is needed.

Obesity and self-reported general health, Hawaii BRFSS: are Polynesians at higher risk?

OBJECTIVE: This study compared the relationship between fair/poor general health status among overweight and obese Polynesians with that among other overweight and obese persons in Hawaii. METHODS AND PROCEDURES: Data were pooled from the 1998-2003 Hawaii Behavioral Risk Factor Surveillance System (BRFSS) and logistic regression used to examine the predictors of fair/poor health status. RESULTS: Polynesians were significantly more likely to be obese than non-Polynesians; overweight Polynesians were more likely than other overweight individuals to report fair/poor health status. After adjusting for confounders, among Polynesians, being obese was no longer associated with fair/poor health. Non-Polynesians who were obese (odds ratio 1.9; 95% confidence interval: 1.4-2.6), older, less educated, smokers, diabetic, hypertensive, and physically inactive were more likely to report fair/poor health. DISCUSSION: Although Polynesians were significantly more obese than the rest of the Hawaii population, their weight was not independently associated with their odds for fair/poor health as it was with non-Polynesians. The difference may be that, for Polynesians, hypertension and diabetes overrode the effect of obesity on general health status or this group maintains different cultural perceptions of body size. Regardless, these findings show a major health risk among Polynesians and suggest the need for culturally specific health interventions.

Effect of race category redefinition on hypertension and hypercholesterolemia prevalence in the behavioral risk factor surveillance system, 1999 and 2001.

Race information in the United States is used to identify populations at risk for cardiovascular disease (CVD) or associated risk factors. Behavioral Risk Factor Surveillance System data from 1999 and 2001 were used to examine shifts in racial distributions and CVD risk factors after a multiracial category was added in 2001. We compared age-adjusted, weighted, race-specific prevalence estimates of self-reported high blood pressure (HBP) and high blood cholesterol (HBC) from 1999 and 2001 with descriptive statistics and 95% confidence intervals. The proportion of non-Hispanic Whites decreased significantly after the multiracial category was added. Overall, the prevalence of HBC did not significantly change, but HBP increased significantly, from 24.2% in 1999 to 25.6% in 2001 (P<.05). Among racial groups, only non-Hispanic Whites showed a statistically significant increase in HBP prevalence from 23.1% to 24.4% (P<.05); however, larger percentage increases in HBP were seen among non-Hispanic Asian/Pacific Islanders (3.5%) and non-Hispanic Blacks (1.6%). Among non-Hispanic Whites, when combining multiracial respondents whose preferred single race was non-Hispanic White, the prevalence of HBP was significantly higher in 2001 than in 1999. The race-specific prevalence of HBP and HBC was virtually unchanged, whether or not multiracial respondents were included in prevalence estimates. Observed HBP increases for non-Hispanic Whites were not caused by the addition of a multiracial category. In 2001, multiracial respondents had the second highest prevalence of HBP after non-Hispanic Blacks. To promote heart health, we must focus on the needs of this emerging multiracial group and on groups with increasing rates of HBP.

Surveillance for certain health behaviors among states and selected local areas--Behavioral Risk Factor Surveillance System, United States, 2003.

PROBLEM: Data on health risk behaviors (e.g., cigarette smoking, binge drinking, and physical inactivity) for chronic diseases and use of preventive practices (e.g., influenza and pneumococcal vaccination for adults aged > or =65 years and cholesterol screening) are essential for developing effective health education and intervention programs and policies to prevent morbidity and mortality from chronic diseases. Continuous monitoring of these behaviors and practices at the state, city, and county levels can help public health programs in evaluating progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2003 are presented for states, selected metropolitan and micropolitan statistical areas (MMSAs), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2003. Within these states and territories, 105 MMSAs and 153 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. Twelve states, 39 MMSAs, and 65 counties achieved the HP 2010 objective to reduce the proportion of adults who engage in no leisure-time physical activity to 20%. Twenty states, 41 MMSAs, and 63 counties achieved the HP 2010 goal of 50% of adults engaging in moderate physical activity for at least 30 minutes per day. The HP 2010 goal of 30% of adults who engage in vigorous physical activity was achieved by 17 states, 33 MMSAs, and 57 counties. Two states, one MMSA, and one county achieved the HP 2010 current cigarette smoking goal of 12% prevalence. One county achieved the HP 2010 binge drinking goal of 6% prevalence among adults. One MMSA and eight counties achieved the HP 2010 goal of 15% for obesity prevalence. The HP 2010 goal for influenza and pneumococcal vaccination coverage of 90% was not achieved by any state, MMSA, or county. No state, MMSA, or county achieved the HP 2010 objective of 17% prevalence of high cholesterol among adults. INTERPRETATION: The findings in this report indicate substantial variation in health risk behaviors and use of preventative services among adults at state and local levels, indicating a need for appropriate public health interventions and continued efforts to evaluate public health programs and policies and health-care-related efforts designed to reduce morbidity and mortality. PUBLIC HEALTH ACTION: Data from BRFSS are useful for assessing national health objectives, for identifying and characterizing at risk populations, and for designing and evaluating health promotion and disease prevention programs and policies. The 2003 BRFSS data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and provides information for measuring progress towards achieving disease prevention and health promotion goals at state and local levels.