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Homeless patients with hepatocellular carcinoma in Osaka City, Japan
Y Sakai1, S Seki, S Nishiguchi
1Department of Public Health, Osaka City University Medical School, Japan.
Insights
Homeless individuals with liver disease often face malnutrition and infections, primarily due to Hepatitis C virus (HCV) and alcohol abuse. Addressing living conditions and reducing alcohol intake may lower hepatocellular carcinoma (HCC) incidence.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Homeless populations face increasing health challenges globally.
- Limited studies explore the specific hepatological health status of homeless individuals.
- Understanding disease pathogenesis and prevention in this demographic is crucial.
Purpose of the Study:
- To analyze the clinicopathological features of hepatocellular carcinoma (HCC) and liver cirrhosis (LC) in homeless patients.
- To identify the primary causes and risk factors associated with liver disease in this population.
- To inform public health strategies for disease prevention and management.
Main Methods:
- Clinicopathological analysis of 30 homeless patients with HCC and 15 with LC.
- Data collected from patients admitted to Osaka Socio Medical center Hospital over six years.
- Focus on patients from the Airin district of Osaka City.
Main Results:
- Homeless HCC patients often had long-term residence in poor hygiene conditions, malnutrition, and high rates of Hepatitis C virus (HCV) and alcohol abuse.
- HCV was the primary cause (77%), followed by alcohol abuse (73%), and their combination (50%).
- Hepatocellular carcinoma (HCC) cases were frequently advanced, with low HCV RNA quantification in HCC patients compared to liver cirrhosis (LC) patients, suggesting high viral load may not be a direct risk factor for HCC development.
Conclusions:
- Prolonged stays in unhygienic environments increase infection risks for the homeless.
- Hepatitis C virus (HCV) and alcohol abuse are major contributors to liver disease in this population.
- Improving living conditions and reducing alcohol consumption are vital for lowering HCC incidence and healthcare costs among the homeless.
Background/Aims:
Although the number of homeless persons is increasing worldwide, studies delineating the health status of these persons according to various medical perspectives, including hepatology, are limited. However, such studies are important for understanding the pathogenesis of diseases and their prevention.
Methodology:
Thirty homeless patients with hepatocellular carcinoma (HCC) and 15 with liver cirrhosis (LC) who were admitted to the Osaka Socio Medical center Hospital during the past 6 years were analyzed clinicopathologically. All were from the Airin district of Osaka City.
Results:
The patients with HCC had a history of long stay (mean: 25 years) in the district and many infectious opportunities and most of them were malnourished. The main causes of liver disease in the patients with HCC were hepatitis C virus (HCV) (77%), alcohol abuse (73%), and the combination of HCV and alcohol abuse (50%). Serum HCV RNA concentration was 10(5.8 +/- 0.9) copies/50 microliters in the 21 HCC patients and 10(6.5 +/- 0.7) copies/50 microliters in the 14 LC patients (p < 0.02). Six HCC patients (20%) were positive for the GB virus C/Hepatitis G virus (GBV-C/HGV) RNA in association with HCV or hepatitis B virus (HBV). Only 2 patients with HCC underwent the curative operations and most of the HCC cases were in progressed stages.
Conclusions:
A long stay in a hygiene-poor environment increases the opportunity for infection in homeless people. The causative agents in the HCC and LC patients were mostly HCV, alcohol abuse, and a combination of the two. Since the quantification of HCV-RNA in the HCC patients was lower, the high level of HCV-RNA may not be a risk factor for the development of HCC. GBV-C/HGV may not also. The reversion to former healthy living conditions and reduction in alcohol consumption as soon as possible may contribute to low incidence of HCC and save the tax dollar expenditures among homeless people.