Liver Cancer Disparities in New York City: A Neighborhood View of Risk and Harm Reduction Factors

Abstract

IntroductionLiver cancer is the fastest increasing cancer in the United States and is one of the leading causes of cancer-related death in New York City (NYC), with wide disparities among neighborhoods. The purpose of this cross-sectional study was to describe liver cancer incidence by neighborhood and examine its association with risk factors. This information can inform preventive and treatment interventions.Materials and methodsPublicly available data were collected on adult NYC residents (n = 6,407,022). Age-adjusted data on liver and intrahepatic bile duct cancer came from the New York State Cancer Registry (1) (2007–2011 average annual incidence); and the NYC Vital Statistics Bureau (2015, mortality). Data on liver cancer risk factors (2012–2015) were sourced from the New York City Department of Health and Mental Hygiene: (1) Community Health Survey, (2) A1C registry, and (3) NYC Health Department Hepatitis surveillance data. They included prevalence of obesity, diabetes, diabetic control, alcohol-related hospitalizations or emergency department visits, hepatitis B and C rates, hepatitis B vaccine coverage, and injecting drug use.ResultsLiver cancer incidence in NYC was strongly associated with neighborhood poverty after adjusting for race/ethnicity (β = 0.0217, p = 0.013); and with infection risk scores (β = 0.0389, 95% CI = 0.0088–0.069, p = 0.011), particularly in the poorest neighborhoods (β = 0.1207, 95% CI = 0.0147–0.2267, p = 0.026). Some neighborhoods with high hepatitis rates do not have a proportionate number of hepatitis prevention services.ConclusionHigh liver cancer incidence is strongly associated with infection risk factors in NYC. There are gaps in hepatitis prevention services like syringe exchange and vaccination that should be addressed. The role of alcohol and metabolic risk factors on liver cancer in NYC warrants further study.

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

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Actionable Solutions to Achieve Health Equity in Chronic Liver Disease

“…Social support 33 , 34 and household situation could contribute to disparities in CLD, because they influence self-care, health behaviors, and treatment adherence. 33 , 35 Differences in experiences with the health care system may result in medical mistrust, which could influence health behaviors. 36 In 1 study, Black patients with HCC had the highest levels of medical mistrust using the Group Based Medical Mistrust Scale, followed by Hispanic, then White patients.…”

Immunotherapy Efficacy in Advanced Hepatocellular Carcinoma in a Diverse and Underserved Population in the United States

“…Under-represented groups have different risk factor profiles for liver disease, a higher incidence of comorbidities, lower enrollment in screening programs, and unequal access to treatment, all culminating in increased mortality. 4 , 5 The advent of immune checkpoint inhibitors (ICI) has revolutionized the treatment of HCC with substantial improvement in outcomes. 6 , 7 However, the efficacy of ICI in underrepresented groups is not well-established due to infrequent inclusion of minority patients in the pivotal trials that led to the widespread adoption of ICI in clinical practice.…”