Hepatocellular carcinoma in Nevada: Impact of HBV/HCV, metabolic syndrome, and alcohol use disorder on age at diagnosis and survival.

523 Background: Hepatocellular carcinoma (HCC) arises from diverse etiologies, most commonly chronic hepatitis B or C infections (HBV; HCV), metabolic syndrome (MetS), and alcohol use disorder. Understanding how these factors (along with their socioeconomic and demographic correlates) influence age at diagnosis, survival, and risk of death is critical for improving prevention and surveillance. Methods: We conducted a retrospective cohort study of 1,231 patients with confirmed HCC diagnosed within the Renown Health system. Patients were stratified by risk factors, including MetS, HBV/HCV, alcohol use disorder, or combinations thereof. Logistic regression was used to assess associations between risk factors and demographics or socioeconomic status, Wilcoxon rank-sum tests compared age at diagnosis, and Cox proportional hazards models evaluated all-cause mortality up to 5 years post-diagnosis, with interaction terms included for combined risk factors. Results: Of the 1,231 patients, 47% had HBV/HCV, 31% MetS, and 46% alcohol use disorder, with frequent overlap. Males were more likely to have HBV/HCV (OR 1.64, 95% CI 1.29–2.10) and alcohol use disorder (OR 2.08, 95% CI 1.63–2.67), whereas no sex difference was observed for MetS. Hispanics were less likely to have HBV/HCV (OR 0.65, 95% CI 0.45–0.94) but showed a trend toward higher MetS prevalence, and non-White patients were more likely to present with HBV/HCV-related HCC. Risk factors were associated with distinct age patterns at diagnosis: HBV/HCV and alcohol use disorder were linked to significantly earlier onset (p < 0.0005) and MetS to later onset (p < 0.0005). In survival analyses of 457 patients who survived at least 30 days after HCC diagnosis and had at least two encounters prior, MetS was associated with increased mortality risk (HR 1.47, 95% CI 1.01–2.12), while HBV/HCV and alcohol use disorder showed no survival differences, and no interactive effects were observed between risk factors. Socioeconomic analysis demonstrated that HBV/HCV (OR 1.45, 95% CI 1.10–1.90) and alcohol use disorder (OR 1.48, 95% CI 1.13–1.94) were significantly more common among patients residing in low-income versus moderate-income census areas, whereas MetS showed no income associations. Conclusions: Distinct HCC etiologies demonstrate divergent demographic, socioeconomic, and prognostic patterns. Among HCC patients, men and patients from low-income census areas were more likely to have HBV/HCV and alcohol use disorder, while MetS is linked to later-onset HCC and poorer survival. These findings highlight the need for tailored prevention and surveillance strategies that address both biological and social determinants of health in HCC.