Dissecting disease, race, ethnicity, and socioeconomic factors for hepatocellular carcinoma: An analysis from the United States Safety Net Collaborative

Rachel M. Lee, Adriana C. Gamboa, Michael K. Turgeon, Adam Yopp, Emily L. Ryon, Joshua P. Kronenfeld, Neha Goel, Annie Wang, Ann Y. Lee, Sommer Luu, Cary Hsu, Eric Silberfein, Shishir K. Maithel, Maria C. Russell

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Racial/ethnic and socioeconomic disparities are assumed to negatively affect treatment and outcomes for hepatocellular carcinoma (HCC). Our aim was to investigate the interaction of racial/ethnic and socioeconomic factors with stage of disease and type of treatment facility in receipt of treatment and overall survival (OS) of patients with HCC. Methods: All patients with primary HCC in the US Safety-Net Collaborative database (2012–2014) were included. Patients were categorized into “safety-net” or “tertiary referral center” based on where they received treatment. Socioeconomic factors were determined at the zip-code level and included median income and percent of adults who graduated from high-school. Primary outcomes were receipt of treatment and OS. Results: On MV Cox regression, neither race/ethnicity, median income, nor care provided at a SNH were associated with decreased OS (all p > 0.05). Independent predictors of decreased OS included lack of insurance (HR 1.34), less educational attainment (HR 1.59) higher MELD score (HR 1.07), higher stage at diagnosis (II:HR 1.34, III:HR 2.87, IV:HR 3.23), and not receiving treatment (HR 3.94) (all p < 0.05). Factors associated with not receiving treatment included history of alcohol abuse (OR 0.682), increasing MELD (OR 0.874), higher stage at diagnosis (III: OR 0.234, IV: OR 0.210) and care at a safety net facility (OR 0.424) There were no racial/ethnic or socioeconomic disparities in receipt of treatment. Conclusions: There is no intrinsic or direct association of race/ethnicity, socioeconomic status, or being treated at select safety-net hospitals with worse outcomes. Poor liver function, no insurance, and advanced stage of presentation are the main determinants of not receiving treatment and decreased survival.

Original languageEnglish (US)
Pages (from-to)120-125
Number of pages6
JournalSurgical Oncology
Volume35
DOIs
StatePublished - Dec 2020

Keywords

  • Disparities
  • HCC

ASJC Scopus subject areas

  • Surgery
  • Oncology

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