Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2016; 22(38): 8584-8595
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8584
Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012
Susan L Stewart, Sandy L Kwong, Christopher L Bowlus, Tung T Nguyen, Annette E Maxwell, Roshan Bastani, Eric W Chak, Moon S Chen Jr
Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
Sandy L Kwong, California Department of Public Health, Sacramento, CA 95817, United States
Christopher L Bowlus, Tung Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
Tung T Nguyen, Eric W Chak, Division of General Internal Medicine, University of California, San Francisco, CA 94101, United States
Annette E Maxwell, Roshan Bastani, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA 90095, United States
Moon S Chen Jr, Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817, United States
Moon S Chen Jr, Cancer Control/Cancer Health Disparities, University of California, Davis Comprehensive Cancer Center, Sacramento, CA 95817, United States
Author contributions: All authors contributed to the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moon S Chen Jr, PhD, MPH., Professor, Associate Director, Cancer Control/Cancer Health Disparities, University of California, Davis Comprehensive Cancer Center, 2450 48th Street, Suite 1600, Sacramento, CA 95817, United States. mschenjr@ucdavis.edu
Telephone: +1-916-7345800
Received: June 28, 2016
Peer-review started: June 28, 2016
First decision: July 29, 2016
Revised: August 16, 2016
Accepted: September 12, 2016
Article in press: September 12, 2016
Published online: October 14, 2016
Processing time: 106 Days and 7.5 Hours
Abstract
AIM

To describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry.

METHODS

Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic (n = 8500), Chinese (n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese (n = 2063), Filipino (n = 1479), Korean (n = 1099), Japanese (n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian (n = 233), South Asian (n = 190), Hawai`ian/Pacific Islander (n = 172), Thai (n = 95), and Other Asian (n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.

RESULTS

After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.

CONCLUSION

Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.

Keywords: Disparities; Treatment; Survival; Liver cancer; Hepatocellular carcinoma

Core tip: We found substantial racial/ethnic differences in treatment and survival in our analysis of 33270 cases of hepatocellular carcinoma from the world’s largest cancer registry in a single geo-political jurisdiction, diagnosed over a 25-year period and disaggregated into 15 racial/ethnic categories. Such granularity provides more precise identification of populations at risk by race/ethnicity, age, gender, socio-economic status, and stage of disease so that targeted interventions to mitigate disparities can be developed.