Hispanics and Liver Disease

By Rita Lepe, MD

According to the 2019 U.S. Census, Hispanics make up 18.5% of the U.S. population (60 million). In Texas, 39.7% of the population is Hispanic (11.5 million) and they primarily live in large urban cities, including San Antonio (63.2%), Dallas (42.4%), Austin (35.1%) and Fort Worth (35%). Hispanics, by definition, are a heterogenous group descending from countries related to Spain, Spanish language and culture. Hispanics can be of any race, although the majority are classified as White, thus the distinction in the Census as Non-Hispanic Whites (NHW) for the Caucasian population.

Chronic liver diseases are very prevalent in the Hispanic population and are a leading cause of death. In 2018, chronic liver disease ranked 7th as a leading cause of overall mortality in Hispanics and the 4th leading cause of death in Hispanic men ages 55-64. The most prevalent liver diseases are non-alcoholic fatty liver disease (NAFLD), chronic hepatitis C, alcoholic liver disease, cirrhosis and liver cancer. Health care disparities exist that are responsible for the increased mortality. It is important to address them to improve long-term health outcomes.

Obesity affects 43% of Hispanics in the U.S. Obesity can lead to the development of NAFLD/NASH which can progress to cirrhosis and liver cancer. Metabolic syndrome affects 35% of U.S. Hispanics and is a risk factor for NAFLD/non-alcoholic steatohepatitis (NASH).

A concerning fact is that Hispanic children have the highest rates of obesity at 25.8% compared to 22% of African American (AA) children and 14% of NHW children. Children can also develop fatty liver, which is currently the most common pediatric liver disease. If not addressed early, these children will go on to develop early onset of DM type 2, hypercholesterolemia and metabolic syndrome at an early age.

Data from NHANES III reported that 2% of Hispanics have chronic hepatitis C. In Hispanics, cure rates of less than 95% are comparable to NHW and other races. Advanced liver disease due to alcohol abuse has a prevalence of 16% higher than that of other ethnic groups. Death due to alcohol-related chronic liver disease is two times higher than in NHW men.

Rates for hepatocellular carcinoma and cholangiocarcinoma are 1.9/100,000 in Hispanics compared to 0.7 for NHW. The death rate is twice as high for Hispanics than NHW due to the fact that Hispanics tend to present with more advanced stage disease and are less likely to receive curative treatments.

Many studies have looked at the effect of race/ethnicity on graft and patient outcomes in patients undergoing liver transplants. Hispanics have equivalent or improved graft and orthotopic liver transplant survival compared to NHW and AA. Hispanics with end-stage liver disease (ESLD) should be promptly referred to transplant programs for evaluation.

Chronic liver disease disproportionately affects Hispanics of all ages. Obesity is also affecting Hispanics at an alarming rate, suggesting that higher rates of NASH and liver cancer will lead to higher rates of mortality. Early intervention addressing the risk factors for chronic liver disease in Hispanics and prevention, especially in the pediatric population, is of extreme importance. Programs need to be developed at the public health level.

Rita Lepe, MD is a Hepatologist with the Texas Liver Institute and is a member of many medical societies including the American Association for the Study of Liver Diseases (AASLD), American Gastroenterology Association (AGA), American Society of Transplantation (AST) and the North Texas Latin American Physician Association (NTLAPA).