Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2018; 24(37): 4281-4290
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4281
Risk factors for liver disease among adults of Mexican descent in the United States and Mexico
Yvonne N Flores, Zuo-Feng Zhang, Roshan Bastani, Mei Leng, Catherine M Crespi, Paula Ramírez-Palacios, Heather Stevens, Jorge Salmerón
Yvonne N Flores, Paula Ramírez-Palacios, Jorge Salmerón, Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos 62000, México
Yvonne N Flores, Roshan Bastani, UCLA Department of Health Policy and Management and Kaiser Permanente Center for Health Equity, Fielding School of Public Health, Los Angeles, CA 90095, United States
Yvonne N Flores, Roshan Bastani, Catherine M Crespi, UCLA Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, United States
Zuo-Feng Zhang, UCLA Department of Epidemiology, Fielding School of Public Health, Los Angeles, CA 90095, United States
Mei Leng, UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA 90095, United States
Catherine M Crespi, UCLA Department of Biostatistics, Fielding School of Public Health, Los Angeles, CA 90095, United States
Heather Stevens, University of Washington, School of Medicine, Seattle, WA 98195, United States
Jorge Salmerón, Universidad Nacional Autónoma de México, Academic Epidemiology Research Unit, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, México
Jorge Salmerón, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos 62100, México
Author contributions: Flores YN, Zhang ZF, Bastani R, Leng M, Crespi CM, Ramírez-Palacios P, Stevens H, Salmerón J contributed to the study design; statistical analysis; interpretation of the findings; writing the article and approval of the final draft.
Supported by the Programa de Investigació; n en Migracion y Salud (PIMSA), No. 2015-2106; the Instituto Mexicano del Seguro Social (IMSS), No. 2005/1/I/093; and the Consejo Nacional de Ciencia y Tecnologí; a (CONACYT), No. 26267M and No. SALUD-2011-01-161930; the NIH, No. UL1TR000124 to Crespi CM, and NIH/NCI No. K07CA197179 to Flores YN.
Institutional review board statement: Approval for both the Health Worker Cohort Study and this bi-national investigation was obtained from the Internal Review Boards of IMSS and UCLA.
Conflict-of-interest statement: All authors declare no potential conflicts of interest relevant to this article.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yvonne N Flores, PhD, Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Blvd. Juárez #31, Colonia Centro, Cuernavaca, Morelos 62000, México. ynflores@ucla.edu
Telephone: +52-777-1001364
Received: June 20, 2018
Peer-review started: June 20, 2018
First decision: July 4, 2018
Revised: August 1, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: October 7, 2018

To compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico.


Data for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors.


After adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans.


In this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

Keywords: Liver disease, Risk factors, Health disparities, Mexico, Mexican Americans, Latinos

Core tip: United States (US) Latinos have greater morbidity and mortality from liver disease than non-Hispanic whites, and liver disease is the fifth leading cause of death in Mexico. Known risk factors for chronic liver disease include hepatitis B or C infection, heavy/binge drinking, obesity, diabetes, and metabolic syndrome. We found that Mexican-Americans in the US have a greater risk of obesity, diabetes and heavy/binge drinking than their counterparts in Mexico. The prevalence of heavy/binge drinking was alarmingly high among Mexican-Americans, with over 70% among males and over 50% among US-born females. Our results identify a high prevalence of specific risk factors that should be targeted to reduce the high rates of liver disease-related mortality in this population.