The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance

Sellers, Cortlandt; Uhlig, Johannes; Ludwig, Johannes; Taddei, Tamar H.; Stein, Stacey; Lim, Joseph K.

doi:10.1002/cam4.2251

Cited by 12 publications

(13 citation statements)

References 33 publications

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“…Enrollees in UEBMI always have a relatively higher SES and may pay close attention to health status, get more cancer screenings, and have full access to medical treatment. Additionally, some studies have also demonstrated that lower SES was associated with worse HCC-specific survival (30)(31)(32). Furthermore, previous studies examining the relationship between insurance and survival in other countries also have shown that patients with a good insurance status have better survival than those with poor insurance status, not only among HCC patients, but also among many other cancers (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Liu

Wang

2021

Front. Public Health

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Objective: Health disparities related to basic medical insurance in China have not been sufficiently examined, particularly among patients with hepatocellular carcinoma (HCC). This study aims to investigate the disparities in HCC survival by insurance status in Tianjin, China.Methods: This retrospective analysis used data from the Tianjin Basic Medical Insurance claims database, which consists of enrollees covered by Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI). Adult patients newly diagnosed with HCC between 2011 and 2016 were identified and followed until death from any cause, withdrawal from UEBMI or URRBMI, or the latest data in the dataset (censoring as of December 31st 2017), whichever occurred first. Patients' overall survival during the follow-up was assessed using Kaplan-Meier and extrapolated by six parametric models. The hazard ratio (HR) and 95% confidence intervals (CI) were calculated with the adjusted Cox proportional hazards model including age at diagnosis, sex, baseline comorbidities and complications, baseline healthcare resources utilization and medical costs, tumor metastasis at diagnosis, the initial treatment after diagnosis and antiviral therapy during the follow-up.Results: Two thousand sixty eight patients covered by UEBMI (N = 1,468) and URRBMI (N = 570) were included (mean age: 60.6 vs. 60.9, p = 0.667; female: 31.8 vs. 27.7%, p = 0.074). The median survival time for patients within the UEBMI and URRBMI were 37.8 and 12.2 months, and the 1-, 3-, 5-, 10-year overall survival rates were 63.8, 50.2, 51.0, 33.4, and 44.4, 22.8, 31.5, 13.1%, respectively. Compared with UEBMI, patients covered by URRBMI had 72% (HR: 1.72; 95% CI: 1.47–2.00) higher risk of death after adjustments for measured confounders above. The survival difference was still statistically significant (HR: 1.49; 95% CI: 1.21–1.83) in sensitivity analysis based on propensity score matching.Conclusions: This study reveals that HCC patients covered by URRBMI may have worse survival than patients covered by UEBMI. Further efforts are warranted to understand healthcare disparities for patients covered by different basic medical insurance in China.

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Section: Discussionmentioning

confidence: 99%

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Liu

Wang

2021

Front. Public Health

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“…15 A wide range of survival durations has been reported for HCC patients from liver transplant programs, 12 and from a mixture of hospitals with or without liver transplant programs on site. 6,13,16 Data on HCC outcomes ascertained from SEER database have limitations of under reporting treatment modalities like TACE or non-reporting of key indicators like HCC surveillance that are associated with early diagnosis and prognosis of HCC. 7 Nonetheless, compared to Adler et al's report and the 20-month survival of our cohort, a lower median survival rate of 18 vs 11 vs 8 months was reported for commercial, Medicaid and uninsured patients respectively from the SEER database.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Survival of Hepatocellular Carcinoma (HCC) Patients at a Safety Net Hospital in Arizona without On-Site Liver Transplant Program

Turse¹,

Aboona²,

Charley³

et al. 2022

JHC

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Background With the rising incidence of hepatocellular carcinoma (HCC), ongoing efforts should be focused on providing equitable and state-of-the-art care to patients. Purpose The aim of this study was to determine the survival of patients with HCC seen at a high-proportion Safety Net Hospital (h-SNH), where loco-regional therapy and hepatology services are available and liver transplantation (LT) is referred to outside facilities. Patients and Methods A retrospective cohort study was conducted on all patients with HCC seen at Valley Wise Health Center (VWHC) over a ten-year period. Clinical variables, treatment modalities, survival duration, hospice, and LT referrals of 161 patients were collected from the medical records. Survival analysis was used to determine the relationship of clinically relevant variables and survival among patients with HCC. A Log rank test was used to compare univariate variables. A Cox regression analysis was used to compare and control for multiple variables. Results Of the 161 patients included in the study, 33% were uninsured. The median age was 59 (21 to >89) years with 47% Hispanic, 31% Caucasian, 15% African American and 7% other races included for the analysis. The median survival for the cohort was 20.1 months. In the multivariate model, insurance status, final MELD, tumor within the Milan criteria and having received treatment for HCC were associated with survival. Surveillance for HCC was associated with HCC in the univariate analysis, but not in the multivariable model. Thirty percent of patients were referred for LT and 1.25% of the entire cohort received it. Conclusion Despite the availability of treatment modalities available for HCC at VWHC and the option of liver transplantation for appropriate candidates at outside centers, OS was less than reported from programs with on-site liver transplant programs. Reasons for lower survival in centers without liver transplant programs should be further studied.

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“…When comparing subgroups according to the initial treatment allocation, the highest mortality rates associated with the Medical Aid group was evident in the TACE group (fully adjusted HR, 2.40; 95% CI, 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04), but not in patients in the curative treatment group (fully adjusted HR, 1.68; 95% CI, 0.39 to 7.13). In a previous study, 10 the authors suggested that while patients with lower SES or less desirable insurance may present with more advanced liver disease or cancer, if they receive the appropriate treatment for their HCC stage and underlying liver disease, their insurance and perhaps even SES may not affect survival. However, in the current study, the lower SES groups showed a more severe impact on the mortality in patients with non-curative treatments.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Socioeconomic Status on Mortality in Patients with Hepatocellular Carcinoma: A Korean National Cohort Study

et al. 2022

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Background/Aims We studied the impact of socioeconomic status (SES) on mortality in hepatocellular carcinoma patients and analyzed the effect of SES on initial treatment allocation. Methods A cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea. A total of 3,032 hepatocellular carcinoma patients who were newly diagnosed between January 2003 and December 2013 were included. Income level was categorized as Medical Aid and ≤30th, 31st–70th, or >70th percentile as an SES indicator. Results The proportion of Medical Aid was 4.3%. The highest risks of all-cause mortality associated with Medical Aid were evident in the transcatheter arterial chemoembolization group (fully adjusted hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04) but not in the curative treatment group. An association between the lower-income percentile and higher liver cancer-specific mortality was also observed, except in the curative treatment group. The association between income percentile and all-cause mortality was nonlinear, with a stronger association in the lower-income percentiles than in the higher income percentiles (p-value for nonlinear spline terms <0.05). Conclusions Patients in the lower SES group, especially patients not eligible for curative treatment, had an increased risk of mortality. In addition, the association between SES and the risk for mortality was stronger in the lower-income percentile than in the moderate to higher income percentiles.

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The impact of socioeconomic status on outcomes in hepatocellular carcinoma: Inferences from primary insurance

Cited by 12 publications

References 33 publications

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Factors Associated with Survival of Hepatocellular Carcinoma (HCC) Patients at a Safety Net Hospital in Arizona without On-Site Liver Transplant Program

The Impact of Socioeconomic Status on Mortality in Patients with Hepatocellular Carcinoma: A Korean National Cohort Study

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