(114) Racial Disparity in Comorbidity Risk Profiles of Early-Onset Liver Cancer: A Case-Control Study Based on the University of California Healthcare Data Warehouse

Background: Early-onset liver cancer presents an increasing incidence in many countries while its etiology is largely unknown. Previous studies identifying risk factors have primarily focused on the Asian population, with limited data on other racial groups.

Objectives: To explore the comorbidity risk profile of early-onset liver cancer and identify key comorbidities across various racial groups.

Methods: Conducting a 1:5 matched case-control investigation utilizing data from the University of California Health Data Warehouse, we examined patients with primary liver cancer diagnosed between 18 and 49 years old from January 2012 to November 20, 2023. Controls without a cancer history were matched by sex, birth year, and racial category. Comorbidities were identified via diagnoses, lab tests, and medication information before liver cancer diagnosis or index dates. AutoML modules on Databricks were utilized to construct predictive machine learning models based on comorbidities and demographic information to assess the risk of early-onset liver cancer across different racial groups. Classification methods including decision trees, random forests, logistic regression, XGBoost, and LightGBM were employed, and the model with the highest F1 score was selected. Shapley values were utilized to identify the ten most crucial comorbidities in each racial group.

Results: A total of 1,597 patients and 7,985 controls were identified, with Asian and Pacific Islanders (API), Hispanic, and White patients comprising 22.1%, 26.2%, and 28.4%, respectively. Compared to White patients, API showed a significantly higher prevalence of Hepatitis B virus (HBV) infection (48.4% vs. 2.9%), while Hispanics exhibited significantly higher rates of hypertension (58.2% vs. 42.6%), cirrhosis (47.7% vs. 27.0%), diabetes (28.1% vs. 15.3%), and Hepatitis C virus (HCV) infection (20.5% vs. 9.2%). Race/ethnicity-specific models for API (F1 score=0.75, AUC=0.87) and Hispanics (F1 score=0.72, AUC=0.89) outperformed the general model (F1 score=0.66, AUC=0.84), but not for Whites (F1 score=0.61, AUC=0.84). HBV infection and cirrhosis were dominant comorbidities among API individuals. Cirrhosis, gastroesophageal reflux disease and peptic ulcers, metabolic syndrome, and HCV infection were notable among Hispanics and Whites. White patients exhibited a more diverse comorbidity profile, with primary sclerosing cholangitis, nicotine dependence, and depressive disorders also showing great importance.

Conclusions: Our study highlights significant racial disparities in comorbidity patterns and risk factors for early-onset liver cancer. Targeted strategies are needed to address these disparities and prevent liver cancer in younger populations.