Association of Nativity with Survival among Adults with Hepatocellular Carcinoma

Document Type


Publication Title

Journal of the National Cancer Institute


Introduction: Immigrants comprise a significant proportion of those diagnosed with hepatocellular carcinoma (HCC) in the United States (US). Nativity or birthplace impacts incidence and risk factors for HCC, but little is known about its influence on survival after diagnosis.

Methods: We identified 51,533 adults with HCC with available birthplace in the California Cancer Registry between 1988 and 2017. Cases were categorized as foreign-born or US-born and stratified by mutually exclusive race and ethnicity groups. Primary outcome was all-cause mortality. Race and ethnicity-specific Cox regression propensity score-weighted models evaluated the relationship between nativity and death, as well as region of birth among foreign-born.

Results: 40% of all HCC cases were foreign-born. 92.2%, 45.2%, 9.1%, and 5.8% of Asian/Pacific Islanders (APIs), Hispanics, Whites, and Blacks were foreign-born, respectively. Five-year survival rates were higher in foreign-born compared to US-born: 12.9% vs 9.6% for Whites, 11.7% vs 9.8% for Hispanics, 12.8% vs 8.1% for Blacks, and 16.4% vs 12.4% for APIs. Nativity was associated with survival, with better survival in foreign-born: White: HR = 0.86 (95% CI 0.81-0.90), Hispanic: HR = 0.90 (95% CI 0.86-0.93), Black: HR = 0.89 (95% CI 0.76-1.05), and API: HR = 0.94 (95% CI 0.88-1.00). Among foreign-born, lower mortality was observed in those from Central and South America compared to Mexico for Hispanics, East Asian compared to Southeast Asia for APIs, and East Europe and Greater Middle East compared to West/South/North Europe for Whites.

Conclusion: Foreign-born with HCC have better survival than US-born. Further investigation into mechanisms of this survival disparity by nativity is needed



Publication Date



Birthplace, Disparities, Immigration, Liver cancer, Mortality