Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

Abstract

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

Reply to Chen et al.

“…Although research in the United States has suggested that factors such as racial disparities and insurance status may affect liver cancer survival rates, 2 it remains to be seen whether these conclusions can be applied to Taiwan, a predominantly homogeneous population with universal healthcare coverage, and this aspect deserves further investigation. Unfortunately, the specific surgical techniques and choices of anesthetic drugs could not be presented in the database.…”

Ground Level Falls in Patients Over 60, Do Race and Socioeconomic Status Affect Outcome?

“…It has been well-documented that race and socioeconomic status have been associated with worse outcomes and higher rates of mortality after emergency general surgery, and surgery for gastric adenocarcinoma, hepatocellular carcinoma, and gastric adenocarcinoma. [6][7][8][9] It is, therefore, possible that race and socioeconomic status influence outcomes after ground-level falls in patients aged >60; however, for our group of patients, this was not the case.…”

Prognostic Analysis on Different Tumor Sizes for 14634 Hepatocellular Carcinoma Patients

“…Moreover, the most common risk factor for HCC globally is the hepatitis B virus. In a previous study, the most common causative agent was the hepatitis C virus [3]. More than 90% of primary liver cancers are HCC [4].…”