Sempokuya T, Patel KP, Azawi M, Ma J, Wong LL. Increased morbidity and mortality of hepatocellular carcinoma patients in lower cost of living areas. World J Clin Cases 2021; 9(23): 6734-6746 [PMID: 34447820 DOI: 10.12998/wjcc.v9.i23.6734]
Corresponding Author of This Article
Tomoki Sempokuya, MD, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198, United States. tsempoku@hawaii.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Clin Cases. Aug 16, 2021; 9(23): 6734-6746 Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6734
Increased morbidity and mortality of hepatocellular carcinoma patients in lower cost of living areas
Tomoki Sempokuya, Kishan P Patel, Muaataz Azawi, Jihyun Ma, Linda L Wong
Tomoki Sempokuya, Muaataz Azawi, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Kishan P Patel, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Jihyun Ma, Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE 68198, United States
Linda L Wong, Department of Surgery, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, United States
Author contributions: Sempokuya T contributed to the study design, data collection, and statistical analysis; Sempokuya T, Patel KP, and Azawi M contributed to the literature review, manuscript drafting, and editing; Ma J contributed to the study design and statistical analysis; Wong LL contributed to study supervision, manuscript drafting and editing; and all of the authors have approved the final version of the manuscript.
Institutional review board statement: Due to utilization of a publicly available, de-identified database, review by our institutional review board was not required.
Informed consent statement: Informed consent was not required to conduct this study.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: All of the data used in this analysis is available from the SEER database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Tomoki Sempokuya, MD, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198, United States. tsempoku@hawaii.edu
Received: March 15, 2021 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 Processing time: 143 Days and 10.5 Hours
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
To investigate the relationship between the COLI and tumor characteristics, treatment modalities, and survival of HCC patients in the United States.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
Future studies should examine this further and explore ways to mitigate the differences.
