Geographic hotspot detection for late-stage hepatocellular carcinoma: novel approach to cancer control

Kali Zhou; Laura K Thompson; Lihua Liu; Norah A Terrault; Myles G Cockburn

doi:10.1007/s10552-022-01555-0

Geographic hotspot detection for late-stage hepatocellular carcinoma: novel approach to cancer control

Cancer Causes Control. 2022 May;33(5):701-710. doi: 10.1007/s10552-022-01555-0. Epub 2022 Jan 27.

Authors

Kali Zhou^{1

2}, Laura K Thompson³, Lihua Liu^{3

4}, Norah A Terrault^{5

6}, Myles G Cockburn^{3

4}

Affiliations

¹ Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. kalizhou@usc.edu.
² USC Research Center for Liver Disease, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. kalizhou@usc.edu.
³ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
⁴ Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
⁵ Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁶ USC Research Center for Liver Disease, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Abstract

Importance: As hepatocellular carcinoma (HCC)-associated mortality continues to rise in the United States, there is a crucial need for strategies to shift diagnoses from late to early stage in order to improve survival.

Objective: To describe a population-based geospatial approach to identifying areas with high late-stage HCC burden for intervention.

Design: Cross-sectional study between 2008 and 2017.

Setting: Los Angeles County.

Participants: All incident cases of HCC with residential address at diagnosis in Los Angeles County were identified from a population-based cancer registry. Late stage included AJCC 7th Edition stages III-IV and unstaged cases.

Exposure: Sociodemographic factors.

Main outcome(s): Geographic "hotspots" or areas with a high density of late-stage HCC, identified using kernel density estimation in ArcMap 10.3.1.

Results: 51.8% of 7,519 incident cases of HCC were late stage. We identified a total of 23 late-stage hotspots, including 30.0% of all late-stage cases. Cases within hotspots were more often racial/ethnic minorities, foreign-born, under or uninsured, and of lower socioeconomic status. The age-adjusted incidence rate of late-stage HCC was twofold higher within hotspots (6.85 per 100,000 in hotspots vs 3.38 per 100,000 outside of hotspots). The calculated population-attributable risk was 43%, suggesting that a substantial proportion of late-stage HCC burden could be averted by introducing interventions in hotspot areas. We mapped the relationship between hotspots and federally qualified health centers primary care clinics and subspecialty clinics in Los Angeles County to demonstrate how clinic partnerships can be selected to maximize impact of interventions and resource use. Hotspots can also be utilized to identify "high-risk" neighborhoods that are easily recognizable by patients and the public and to facilitate community partnerships.

Conclusion and relevance: Reducing late-stage HCC through geographic late-stage hotspots may be an efficient approach to improving cancer control and equity.

Keywords: Disparities; Geographic information system; Geospatial methods; Implementation science; Liver cancer.

MeSH terms

Carcinoma, Hepatocellular* / diagnosis
Carcinoma, Hepatocellular* / epidemiology
Carcinoma, Hepatocellular* / pathology
Cross-Sectional Studies
Ethnicity
Humans
Incidence
Liver Neoplasms* / epidemiology
Liver Neoplasms* / pathology
United States

Abstract

MeSH terms

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