Targeting population groups with heavier burden of hepatocellular carcinoma incidence: A nationwide descriptive epidemiological study in Sweden

Abstract

Contemporary European studies examining associations between socioeconomic status and hepatocellular carcinoma (HCC) incidence are scarce. We aimed to target population groups with a heavier burden of HCC by assessing associations of individual‐level sociodemographic variables and neighbourhood deprivation with all‐stage and stage‐specific HCC incidence rates (IR). Patient and population data stratified by calendar year (2012‐2018), sex, age (5‐year groups), household income (low, medium and high), country of birth (Nordic, non‐Nordic) and neighbourhood deprivation (national quintiles Q1‐Q5) were retrieved from Swedish registers. HCC stages were defined by Barcelona Clinic Liver Cancer stages 0 to A (early‐stage) and B to D (late‐stage). IR (per 100 000 person‐years) were estimated by Poisson regression models. Men had four times higher IR than women. IRs increased markedly with lower household income as well as with neighbourhood deprivation. Seven times higher IR was observed among people with a low household income living in the most deprived neighbourhoods (IR 3.90, 95% confidence interval [CI] 3.28‐4.64) compared to people with a high household income living in the least deprived neighbourhoods (IR 0.58, 95% CI 0.46‐0.74). The gradient across income categories was more pronounced for late‐stage than early‐stage HCC. IR reached 30 (per 100 000 person‐years) for people in the age span 60 to 79 years with low income and 20 for 60 to 79 year old people living in the most deprived neighbourhoods (regardless of income). Men with low household income and/or living in the most deprived neighbourhoods might be considered as primary targets in studies evaluating the cost‐effectiveness of screening for early‐stage HCC detection.

Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients

“…The Swedish welfare system is characterized by its tax‐financed structure, which aims to offer equal access and use of health care. Despite this welfare orientation, HCC has been reported to be one of Sweden's most socioeconomically polarized malignancies [ 22 ]. The incidence of HCC is seven times higher in the most economically deprived patients compared to the wealthiest [ 22 ].…”

“…Despite this welfare orientation, HCC has been reported to be one of Sweden's most socioeconomically polarized malignancies [ 22 ]. The incidence of HCC is seven times higher in the most economically deprived patients compared to the wealthiest [ 22 ]. Even after adjusting for other sociodemographic variables, etiology, liver disease severity, comorbidity, and BCLC stage, patients with a low household income had worse survival than the wealthiest patients.…”

“…Household income (disposable income per household per consumption unit) was chosen as the indicator of individual‐level socioeconomic status [ 22 ]. Other individual‐level indicators, such as occupational social class or education, are more often associated with missing data for immigrants, which is not the case with household income [ 22 ].…”

“…Household income (disposable income per household per consumption unit) was chosen as the indicator of individual‐level socioeconomic status [ 22 ]. Other individual‐level indicators, such as occupational social class or education, are more often associated with missing data for immigrants, which is not the case with household income [ 22 ]. Each patient was categorized as having a low, medium, or high household income based on the distribution of household income across all households in Sweden (Table S1 ) [ 22 ].…”

“…BCLC stage was chosen as a proxy for other clinically important patient‐ and tumor‐associated variables. The BCLC stage variable had a high level of completeness (98%), which was not the case for other individual‐level tumor‐related variables or performance status (Table S1 ) [ 22 ].…”