Temporal Trends of Health Disparity in the Utilization of Curative-Intent Treatments for Hepatocellular Carcinoma- Are we making progress?

Emeka P Agudile; Eduardo A Vega; Oscar Salirrosas; Ukamaka M Agudile; Ariana M Chirban; Christopher Lathan; George P Sorescu; Bruno C Odisio; Elena Panettieri; Claudius Conrad

doi:10.1016/j.gassur.2024.05.015

Temporal Trends of Health Disparity in the Utilization of Curative-Intent Treatments for Hepatocellular Carcinoma- Are we making progress?

J Gastrointest Surg. 2024 May 14:S1091-255X(24)00456-6. doi: 10.1016/j.gassur.2024.05.015. Online ahead of print.

Authors

Affiliations

¹ Department of Medicine, Steward Carney Hospital, Dorchester, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Surgery, St. Elizabeth's Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
³ Department of Medicine, Steward Carney Hospital, Dorchester, MA, USA.
⁴ Department of Surgery, St. Elizabeth's Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; University of California San Diego, School of Medicine, La Jolla, CA, USA.
⁵ Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard School of Medicine, Boston, MA.
⁶ Department of Medicine, Lemuel Shattuck Hospital, Boston, MA, USA.
⁷ Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Department of Surgery, St. Elizabeth's Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁹ Surgical Oncology, Carle Illinois College of Medicine, Urbana Champaign, IL, USA. Electronic address: cc@claudiusconrad.com.

PMID: 38754809
DOI: 10.1016/j.gassur.2024.05.015

Abstract

Background: Liver-directed treatments: ablative therapy (AT), surgical resection (SR), liver transplantation (LT), as well Trans-Arterial Chemoembolization (TACE) improve OS for early-stage HCC. While racial and socioeconomic disparities impact access to liver-directed therapies, their temporal trends for the curative-intent treatment of HCC remain to be elucidated.

Methods: We performed chi-square, logistic regression, and temporal trends analyses on data from the Nationwide Inpatient Sample from 2011-2019. The outcome of interest was the rate of AT, SR, LT (curative-intent treatments), and TACE utilization, and the primary predictors were racial/ethnic group, and SES (insurance status).

Results: African-American and Hispanic patients had lower odds of receiving AT - (African-American: OR=0.78, p<0.001), (Hispanic: OR=0.84, p=0.005); and SR - (African-American: OR=0.71, p<0.001), (Hispanics: OR=0.64, p<0.001) compared with white patients. The odds of LT was lower for African-American (OR=0.76, p<0.001) but higher for Hispanic patients (OR=1.25, p=0.001) compared to white patients. Low SES had worse odds of AT (OR=0.79, p=0.001), SR (OR=0.66, p<0.001), and LT (OR=0.84, p=0.028) compared to high SES. While curative-intent treatments showed significant upward temporal trends among White (10.6% to 13.9%, p<0.001), and API/Other patients (14.4% to 15.7%, p=0.007), there were non-significant trends among African-American (10.9% to 10.1%, p=0.825) or Hispanic patients (12.2% to 13.7%, p=0.056).

Conclusions: Our study demonstrates concerning disparities in the utilization of curative-intent treatment for HCC based on race/ethnicity, and socioeconomic status. Moreover, racial/ethnic disparities have widened rather than improved over time.

Keywords: ablative treatment; access to care; curative-intent treatment; disparities; hepatocellular carcinoma; liver transplantation; liver-directed therapy; surgical resection; transarterial chemoembolization.