American Journal of Epidemiology Vol. 136, No. 9: 1115-1121
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Age at First Establishment of Chronic Hepatitis B Virus Infection and Hepatocellular Carcinoma Risk
A Birth Order Study
1Department of Epidemiology, Harvard School of Public Health Boston, MA.
2Department of Hygiene and Epidemiology, University of Athens Medical School Athens, Greece
3School of Public Health, Kaohsiung Medical College Kaohsiung, Taiwan
Reprint requests to Dr. Chung-Cheng Hsieh, Depart-ment of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
It is frequently assumed that the risk of hepatocellular carcinoma related to hepatitis B virus is higher when chronic hepatitis B virus infection is acquired early in life. This hypothesis has never been directly evaluated. However, firstborn and second born children are exposed to common infections after their school enrollment, whereas later-born children are exposed much earlier, through their older siblings. The authors analyzed sibship size and birth order data from a large case-control study of patients admitted to Athens, Greece, hospitals between April 1976 and October 1984. The analyses included 185 patients with hepatocellular carcinoma, 35 patients with metastatic liver cancer, and 432 other hospital controls. There was a tendency for cases of hepatocellular carcinoma to concentrate at higher birth orders. When the analysis was restricted to cases and controls who were positive for hepatitis B surface antigen, this tendency was even more notable. These results are compatible with the hypothesis that establishment of chronic hepatitis B virus infection at an early age increases the risk of hepatocellular carcinoma substantially more than does chronic infection with this virus established at a later age. Am J Epidemiol 1992; 136: 1115–21
birth order; family characteristics; hepatitis B virus; hepatoma
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