© 1998 Oxford University Press
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Hepatitis B vaccination and reduced risk of primary liver cancer among male adults: a cohort study in Korea
aDepartment of Preventive Medicine, University of Ulsan College of Medicine 388-1 Songpa-gu, Poongnap-dong, Seoul 138-040, Korea
bDepartment of Social Medicine, College of Medicine, Hallym University #1 Okchon-dong, Chunchun, Kangwon-do 200-703, Korea
cDepartment of Preventive Medicine, College of Medicine, Chungbuk National University 48 San Gaeshin-dong, Cheongju 360-763, Korea
dDepartment of Internal Medicine, Seoul National University College of Medicine 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
eKorea Medical Insurance Corporation 168-9 Yeomni-dong, Mapo-gu, Seoul 121-749, Korea
fDepartment of Preventive Medicine, Seoul National University College of Medicine 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea
BACKGROUND: Primary liver cancer is an important health problem in Korea, where hepatitis B virus (HBV) infection is prevalent. The authors conducted a prospective cohort study to evaluate the protective effect of HBV vaccination against liver cancer in adults.
METHODS: A total of 370 285 males aged 
30 comprised the study population. They were clinically free of liver diseases, and had not been vaccinated against HBV at enrolment. The results of HBV surface antigen (HBsAg) and antibody to HBsAg (antiHBs) marker positivity and those of the vaccination programme which took place during 1985 were used for the construction of the cohort. About 5% (n = 18 914) were HBsAg positive, 78 094 were anti-HBs positive, and 273 277 were negative for both. Among the candidates for HBV vaccination (n = 273 277), 35 934 (13.2%) people had been vaccinated against HBV during 1985. Cases of liver cancer were ascertained by record linkage and from medical records covering 1986–1989. A multivariate log-linear model was used to test statistical significance and to estimate relative risks (RR).
RESULTS: The total follow-up period was 1 404 566 person-years, with an average of 3 years and 10 months. A total of 302 incident cases were ascertained. The overall incidence rate of liver cancer was 21.7 per 100 000 person-years. With reference to the incidence level among the unvaccinated and uninfected, the RR of primary liver cancer among the chronically infected and that of the unvaccinated and infected was 18.1 (95% CI: 14.2–22.9) and 0.34 (95% CI: 0.19–0.60), respectively. The RR among the vaccinated group was 0.58 (95% CI: 0.31–1.09).
CONCLUSIONS: This study suggested that artificial immunization through HBV vaccination, even in adulthood, reduces the risk of liver cancer. It might also offer a practicable means of primary prevention, especially in areas with hyperendemidty of HBV infection.
Keywords Hepatitis B virus, vaccination, prevention, primary liver cancer, cohort study
Accepted 17 July 1997
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