Racial/Ethnic Disparities in Access to Care and Survival for Patients With Early-Stage Hepatocellular Carcinoma

Mathur, Amit K.; Osborne, Nicholas H.; Lynch, Raymond; Ghaferi, Amir A.; Dimick, Justin B.; Sonnenday, Christopher J.

doi:10.1001/archsurg.2010.272

Cited by 132 publications

(124 citation statements)

References 12 publications

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“…Multiple studies have shown that black patients are less likely to receive surgical management of HCC, which is generally an option for patients with better preserved liver function [11,[14][15][16]. Sloane and his colleagues reported that black patients with localized HCC defined as disease confined to the initial organ without evidence of spread were more likely to have "surgery not recommended" (45% versus about 37%) and less likely to have "surgery performed" (20% versus 30%) when compared to white patients (p<0.001) [11].…”

Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

“…Mathur, et al found that black and Hispanic patients received invasive therapy defined as tumor ablation, hepatectomy or liver transplant at lower rates than whites and Asians (p<0.001) [14]. The authors cited poor access to complex cancer care as a potential contributor to this disparity.…”

Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

“…It is also well established that black patients with HCC have lower survival rates [11,[14][15][16]. Sloane, et al found that among their cohort, survival for black patients with HCC was lower than for white patients after adjusting for age, gender, tumor stage and surgical treatment intervention used (HR 95% CI=1.041-1.2, p=0.002).…”

Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

“…Perhaps as a consequence, African Americans have more advanced tumor stage at diagnosis and receive definitive surgical treatment less often than other racial groups. Most concerning is that African Americans with HCC have higher mortality than other ethnicities [11][12][13][14][15][16]. This review examines the factors that might contribute to increased HCC risk and mortality among African Americans.…”

Section: Introductionmentioning

confidence: 99%

“…These include greater exposure to agents that cause liver damage (e.g. chronic hepatitis C virus (HCV) infection and hepatitis B virus (HBV) infection), less access to healthcare [14] and, potentially, biological and histological differences in the HCC tumor subtype.…”

Section: Introductionmentioning

confidence: 99%

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Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

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2017

Austin J Gastroenterol

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Liver cancer remains an important cause of cancer mortality in the United States. Incidence of hepatocellular carcinoma (HCC), the most common histological cell type of liver cancer, has increased over the past 30 years. The statistics are particularly worrisome for African Americans. Their incidence of HCC far surpasses that of other races, particularly whites. Additionally, mortality for African Americans with HCC is also far worse. In a review of the literature, we found a stepwise progression of variables that may contribute to this observation. African Americans have the highest observed rates of infection with chronic hepatitis and are offered treatment less often for hepatitis C virus. The progression to cirrhosis is slower, which may complicate HCC surveillance. Regardless, they receive surveillance either biochemical or radiographic at a lower rate than patients of other races. Further, African Americans present at a more advanced stage and are referred for curative therapy less often. When African Americans do receive therapy, their outcomes are worse. Additional investigation is warranted as to whether differences in tumor biology may also play a role.

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Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

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2017

Austin J Gastroenterol

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Exposure to Agent Orange and Hepatocellular Carcinoma Among US Military Personnel

Benhammou,

Leng,

Shah

et al. 2023

JAMA Netw Open

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ImportanceHepatocellular carcinoma (HCC) and its mortality are on the rise. Viral hepatitis and alcohol are leading risk factors; however, other risk factors among veterans are less defined, including Agent Orange (AO), an herbicide linked to several cancers.ObjectiveTo assess the association of AO exposure and HCC in a national cohort of Vietnam veterans.Design, Setting, and ParticipantsThis retrospective cohort study included Vietnam veterans who served between 1966 and 1975, were male, were older than 18 years at the time of deployment, and had established follow-up in the Veterans Affairs (VA) between 2000 and 2019. Veterans with AO exposure were identified in the disability data via validated clinical surveys. Relevant clinical risk factors for cirrhosis and HCC were collected. Patients were stratified based on cirrhosis status, as defined by consecutive diagnosis found by documented International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision scores or calculated Fibrosis-4 scores. Data were collected from January 1, 2019, to December 31, 2020, and analyzed from December 2020 to October 2023.Main Outcome and MeasuresIncident HCC was the primary outcome. AO and HCC association was estimated using a multivariable Cox regression analysis, with death and liver transplant as competing events.ResultsOf the 296 505 eligible veterans (222 545 [75.1%] White individuals and 44 342 [15.0%] Black individuals), 170 090 (57%) had AO exposure (mean [SD] age, 21.62 [3.49] years; 131 552 White individuals [83.2%] and 22 767 Black individuals [14.4%]) and 35 877 (12.1%) had cirrhosis. Veterans who were not exposed to AO were more likely to smoke (109 689 of 126 413 [86.8%] vs 146 061 of 170 090 [85.9%]); use alcohol (54 147 of 126 413 [42.8%] vs 71 951 of 170 090 [42.3%]) and have viral hepatitis (47 722 of 126 413 [37.8%] vs 58 942 of 170 090 [34.7%]). In a multivariable competing risk model, AO exposure was not associated with HCC. Among veterans with cirrhosis, self-identification as Hispanic individuals (aHR, 1.51; 95% CI, 1.30-1.75; P &lt;.001) or Black individuals (aHR, 1.18; 95% CI, 1.05-1.32; P = .004), and having a diagnosis of viral hepatitis (aHR, 3.71; 95% CI, 3.26-4.24; P &lt;.001), alcohol-associated liver disease (aHR, 1.32; 95% CI, 1.19-1.46; P &lt;.001), and nonalcoholic fatty liver disease (NAFLD) (aHR, 1.92; 95% CI, 1.72-2.15; P &lt;.001) were associated with HCC. Among veterans without cirrhosis, hypertension (aHR, 1.63; 95% CI, 1.23-2.15; P &lt;.001) and diabetes (aHR, 1.52; 95% CI, 1.13-2.05; P = .005) were also associated with HCC. Early smoking and alcohol use were significant risk factors for HCC.Conclusions and RelevanceIn this large nationwide cohort study of Vietnam veterans, AO exposure was not associated with HCC. Smoking, alcohol, viral hepatitis, and NAFLD were the most important clinical risk factors for HCC.

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Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

et al. 2017

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Pancreatic neuroendocrine tumor (pancreatic NETs), is an important cause of cancer‐related death worldwide. No study has rigorously explored the impact of ethnicity on pancreatic NETs. We aimed to demonstrate the relationship between ethnicity and the survival of patients with pancreatic NETs. We used the SEER database to identify patients with pancreatic NETs from 2004 to 2013. Kaplan–Meier methods and Cox proportional hazard models were used to evaluate the impact of race on survival in pancreatic NETs patients. A total of 3850 patients were included: 3357 Non‐Blacks, 493 Blacks. We stratified races as “Black” and “White/Other.” Blacks were more likely to be diagnosed with later stages of tumors (P = 0.021). As for the treatment, the access to surgery seemed to be more limited in Blacks than non‐Black patients (P = 0.012). Compared with non‐Black patients, Black patients have worse overall survival (OS) (HR = 1.17, 95% CI: 1.00–1.37, P = 0.046) and pancreatic neuroendocrine tumors specific survival (PNSS) (HR = 1.22, 95% CI: 1.01–1.48, P = 0.044). Multivariate Cox analysis identified that disease extension at the time of diagnosis and surgical status contributed to the ethnical survival disparity. Black patients whose stages at diagnosis were localized had significantly worse OS (HR = 2.09, 95% CI: 1.18–3.71, P = 0.011) and PNSS (HR = 3.79, 95% CI: 1.62–8.82, P = 0.002). As for the patients who did not receive surgery, Blacks also have a worse OS (HR = 1.18, 95% CI: 1.00–1.41, P = 0.045). The Black patients had both worse OS and PNSS compared to non‐Black patients. The restricted utilization of surgery, and the advanced disease extension at the time of diagnosis are the possible contributors to poorer survival of Blacks with pancreatic NETs.

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Racial/Ethnic Disparities in Access to Care and Survival for Patients With Early-Stage Hepatocellular Carcinoma

Cited by 132 publications

References 12 publications

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Exposure to Agent Orange and Hepatocellular Carcinoma Among US Military Personnel

Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

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