Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6734
Peer-review started: March 15, 2021
First decision: April 6, 2021
Revised: April 11, 2021
Accepted: June 25, 2021
Article in press: June 25, 2021
Published online: August 16, 2021
The incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in the United States. However, the increases in different racial and socioeconomic groups have not been homogeneous.
Access to healthcare based on socioeconomic status and cost of living index (COLI), especially in HCC management, is under characterized. Therefore, a study to characterize disparity in HCC care is needed.
To investigate the relationship between the COLI and tumor characteristics, treatment modalities, and survival of HCC patients in the United States.
A retrospective study of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HCC between 2007 and 2015. Interquartile ranges for COLI were obtained and were used to separate the study population into four groups: COLI ≤ 901, 902-1044, 1045-1169, ≥ 1070. The χ2 test was used to compare categorical variables, and the Kruskal-Wallis test was utilized to compare continuous variables without normal distributions. Survival analysis was done by the Kaplan-Meier method.
We identified 47,894 patients with HCC. Patients from the highest COLI areas were more likely to have stage I disease (34.2% vs 32.6%), tumor size ≤ 30 mm (27.1% vs 23.1%), have received locoregional therapy (11.5% vs 6.1%), and undergone surgical resection (10.7% vs 7.0%) compared with the lowest quartile. Patients from lower COLI were more likely to be uninsured (5.7% vs 3.4%), have stage IV disease (15.2% vs 13%), and have received a liver transplant (6.6% vs 4.4%) compared with patients from the highest COLI. The median survival increased with increasing COLI; from 8 (95%CI: 7-8), to 10 (95%CI: 10-11), 11 (95%CI: 11-12), and 14 (95%CI: 14-15) mo (P < 0.001) in the COLI ≤ 901, 902-1044, 1045-1169, ≥ 1070 groups, respectively.
Our study suggested that there were racial and socioeconomic disparities in HCC. Patients from lower COLIs presented with more advanced disease, and increasing COLI was associated with improved median survival.
Future studies should examine this further and explore ways to mitigate the differences.