PURPOSE Sub-Saharan Africa carries one of the highest burdens of hepatocellular carcinoma (HCC) in the world, with hepatitis B (HBV) as the most common cause. Globally, there is evidence that rural communities experience disproportionate cancer morbidity compared to urban ones. However, no study has examined these differences in Africa. METHODS We performed a systematic review of studies on HCC in Africa, later completing a meta-analysis using data from those studies to assess mean age, proportion of males, and of HBV positive patients in relation to location of the study. Using land-use/land cover data available from European Space Agency sentinel imagery on Africa, we categorized locations and calculated the distance in kilometers from each study site to the closest rural area (agricultural land). These distances were divided into halves and subsequent quartiles. Logistic regression models were fit to estimate 1) the association between distance to the closest rural area and HBV and 2) the association between distance to the closest rural area and gender. Weighted mean age was calculated for each quartile. RESULTS 978 studies were retrieved through electronic database search. After removing duplicates and relevance, fifty-seven articles were included. Data on 10,608 patients was used in the meta-analysis across 19 countries in Africa. 74% of patients were male and the weighted mean age was 52.5 years. Proximity to a rural area was associated with increased odds of HBV after controlling for country, with locations closest to a rural region (<3.2 km) having 3.1 times higher odds of HBV-HCC (95% CI 2.65 - 3.60, p <0.001) compared to patients in locations furthest from rural areas (>9.5 km). When analyzing only studies in West Africa, those in locations closest to rural areas also showed higher odds of HBV-HCC (OR: 1.43, 95% CI 1.15-1.76, p<0.001) compared to those furthest from rural areas. However, patients in studies between 6.3 and 9.5 km had decreased odds of HBV (OR: 0.42, 95% CI 0.28-0.63, p<0.001). No association was found between proximity to a rural area and gender or age (50, 53, 47 and 53 y/o, respectively, per distance quartile). CONCLUSION We found an association between proximity to a rural area and odds of HBV-associated HCC in Africa in the first study of its kind. Further research is needed to understand the burden of HBV-related HCC in Africa across rural and urban areas.
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Mann et al. (2024) studied this question.