African Americans are less likely to receive curative treatment for hepatocellular carcinoma

Abstract

AIMTo determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma (HCC).METHODSA retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.RESULTSA total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant (OR: 2.66, 95%CI: 1.92-3.68), resection (OR: 1.82, 95%CI: 1.48-2.23), and ablation (OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant (OR: 2.18, 95%CI: 1.40-3.39) and ablation (OR: 1.46, 95%CI: 1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant (OR: 2.41, 95%CI: 1.62-3.61), resection (OR: 1.79 95%CI: 1.39-2.32), and ablation (OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between races.CONCLUSIONRacial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.

Higher expression of SATB2 in hepatocellular carcinoma of African Americans determines more aggressive phenotypes than those of Caucasian Americans

“…Specifically, SATB2 was induced by pancreatic ductal epithelial cells when they were exposed to chronic ethanol, a condition generates reactive oxygen species (ROS). 19 Epidemiological data suggest that poor socio-economic conditions, inadequate access to screening and treatment opportunities may create stressful and inflammatory environment, [46][47][48][49][50][51][52] which may induce SATB2. This hypothesis needs to be tested in HCC disparities.…”

Comparison of Liver Transplant Wait-List Outcomes Among Patients With Hepatocellular Carcinoma With Public vs Private Medical Insurance

“…Black patients were also the least likely to undergo curative therapy for HCC compared with white and Hispanic patients. 7 Another study found that black patients were significantly less likely to undergo an LT despite similar severity of liver disease, tumor characteristics, and insurance status. 8 Insurance type has also been shown to affect access to care for patients with HCC.…”

“…Black patients have incidence rates 2-fold that of white patients, and in a 2018 Surveillance, Epidemiology and End Results database study, the overall 5-year survival rate for patients with HCC was lower among black patients than any other racial group. Black patients were also the least likely to undergo curative therapy for HCC compared with white and Hispanic patients . Another study found that black patients were significantly less likely to undergo an LT despite similar severity of liver disease, tumor characteristics, and insurance status .…”

Cystic fibrosis patients on cystic fibrosis transmembrane conductance regulator modulators have a reduced incidence of cirrhosis

“…Patients were also excluded if they did not have at least 12 months of follow up after initiation of a CFTR modulator and/or ursodiol, periods of non-continuous drug claims enrollment, and no prescription coverage for any of the enrollment period. Diagnostic codes for each of these inclusion and exclusion criteria have been widely used in previous publications[ 18 , 19 ].…”