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Disparities in Surgical Oncologic Care

E129: Multilevel Factors for Racial/Ethnic and Socioeconomic Disparities in Timely, Guideline Concordant Care of Hepatocellular Carcinoma

Introduction: Racial and ethnic disparities have been reported following hepatocellular carcinoma (HCC) diagnosis, although due to lack of granularity in administrative datasets few studies fully account for clinically important factors and social determinants of health, including neighborhood socioeconomic status (SES), underlying liver function, and residential racial segregation. We characterized racial and ethnic differences in the receipt of timely HCC guideline concordant care in a multi-center cohort of patients.

Methods: We performed a retrospective cohort study of patients newly diagnosed with HCC from January 2010 through August 2018 at four large health systems in the U.S. We used multivariable logistic regression and Cox proportional hazard model, with competing risk correction, using nested models with increasing introduction of covariates to the receipt of timely (< 3 months from diagnosis), guideline concordant care amongst Black, Hispanic and, non-Hispanic White patients with early-stage HCC.

Results: Of 2263 patients with HCC (37.6% non-Hispanic White, 23.5% Black, 32.6% Hispanic, 6.4% Asian/Other), 42.0% of patients presented at an early stage (BCLC stage 0/A). In fully adjusted models there were persistent Black-White disparities in early-stage presentation (OR 0.65, 95%CI 0.47 – 0.90), but not Hispanic-White disparities (OR 0.91, 95%CI 0.68 – 1.21) (Figure 1a). In early-stage HCC, median survival was 69.1 (IQR 52.5-85.9) months for White patients, compared to NR months for Hispanic, 51.8 (IQR 31.5-72.1) months for Black, and 48.9 (IQR 29.5-68.2) months for Asian/Other patients. In univariate and fully adjusted models in early-stage HCC, there was no differences in the receipt of treatment within three months following diagnosis amongst White, Black, and Hispanic patients. However, in fully adjusted models there was Black-White (HR 1.72, 95%CI 1.15-2.48) and Hispanic-White (HR 0.66. 95%CI 0.45-0.98) disparities in the receipt of curative treatment.

Conclusions: We observed persistent, significant Black-White disparities for early tumor detection in fully adjusted models. Black-White disparities in early stage survival may be related to differences in the receipt of curative treatment. Further studies should refine potential intervention targets to reduce sociodemographic disparities in the future.

Learning Objectives:

  • describe disparities between Black, White, and Hispanic populations presenting with early-stage hepatocellular carcinoma.
  • describe what may be contributing to the differences in Black-White early stage survival.
  • discuss factors associated with early-stage hepatocellular carcinoma presentation.