Background Risk factors for hepatocellular carcinoma (HCC) have not been well characterized among African immigrants with chronic hepatitis B virus (HBV) infection. We conducted a case-control study to identify demographic and clinical factors associated with HCC among a diverse cohort of patients with chronic HBV infection seen in a large academic health setting. Methods We identified a total of 278 patients with HCC and chronic HBV seen at two medical centers in a 14-year span from January 2002 to December 2015. These cases were age- and sexmatched in a 1:3 ratio with 823 non-cancer control subjects with chronic HBV. Conditional logistic regression was used to estimate the odds of HCC by race, with black race stratified by African-born status, after adjusting for diabetes, HIV or HCV coinfection, alcohol misuse and cirrhosis. Results Of the 278 HCC cases, 67% were 60 years of age or older, 78% were male, 87% had cirrhosis and 72% were Asian. HIV infection was present in 6% of cases. Only 7% (19 of 278) of HCC cases were black, of whom 14 were African immigrants. The median age at HCC diagnosis was 44 years in Africans. Notably, nearly all (93%) of the African-born patients with HCC were diagnosed at an age younger than 60 years compared with 52% of Asian cases (P<0.001). The main factors independently associated with greater odds of HCC overall were Asian race (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 1.9-5.5) and cirrhosis (aOR 19.7, 95% CI 12.2-31.8). Conclusion African immigrants accounted for a small proportion of HBV-associated HCC cases overall compared with Asians but appeared to have greater likelihood of early-onset HCC. Optimal strategies for HCC prevention in these key subroups with chronic HBV warrant further study. © 2018 Kennedy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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liver tumor Liver Neoplasms Asian HIV Infections Human immunodeficiency virus infection university hospital Carcinoma, Hepatocellular complication Continental Population Groups human ancestry group alcohol liver cirrhosis middle aged birthplace statistics and numerical data diabetes mellitus controlled study Aged cancer prevention African ethnology United States Humans migrant Black person virology Severity of Illness Index male Emigrants and Immigrants female Aged, 80 and over very elderly risk factor Risk Factors Africa liver cell carcinoma Coinfection Article major clinical study adult Hepatitis B, Chronic age alcohol abuse Age Factors chronic hepatitis B cohort analysis cancer diagnosis Case-Control Studies disease severity disease burden case control study onset age mixed infection hepatitis C