We analyzed data from the first study of
iron overload in Africans, conducted between 1925 and 1928, to determine whether this common condition is associated with death from
hepatocellular carcinoma and/or
tuberculosis. In the original study, necropsies were performed on 714 adult blacks from southern Africa. Hepatic and splenic
iron levels were measured semiquantitatively in 604 subjects and one of five
iron grades was assigned. We examined death from
hepatocellular carcinoma or from
tuberculosis and the variables of age, sex, the presence of
cirrhosis or other diagnoses that might be influenced by
iron status, and tissue
iron grades. Nineteen percent of men and 16% of women had the highest grade of hepatic
iron. After adjustment for the presence of
cirrhosis, hepatic iron grade was the variable most significantly associated with death from
hepatocellular carcinoma (P = .021). The odds of death from
hepatocellular carcinoma in subjects with the highest grade of hepatic
iron was 23.5 (95% confidence interval, 2.1 to 225) times the odds in subjects with the three lowest grades. Splenic
iron was the variable most significantly associated with death from
tuberculosis (P <.0001). The odds of death from
tuberculosis with the highest grade of splenic
iron was 16.9 (4.8 to 59.9) times the odds with the two lowest grades. These findings suggest that
iron overload in black Africans may be a risk factor for death from
hepatocellular carcinoma and for death from
tuberculosis.