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

Abstract

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.

An observational study of socioeconomic status and demographic profile of advanced cancer patients receiving palliative care in tertiary care institution of Bihar, India

“…Patients with higher financial hardship ratings had worse functional wellbeing, lower emotional wellbeing, higher anxiety, and higher depression scores, according to Jacob and colleagues [3]. Socioeconomic status was shown by few studies as an independent risk factor for death in cancer patients [22]. According to research by Hapurachi et al [22], patients with low SES reported lower physical, emotional, spiritual, and social EOL outcomes than those with high SES [5].…”

“…Socioeconomic status was shown by few studies as an independent risk factor for death in cancer patients [22]. According to research by Hapurachi et al [22], patients with low SES reported lower physical, emotional, spiritual, and social EOL outcomes than those with high SES [5]. Following a diagnosis of advanced cancer, poor households in low-income countries are exposed to catastrophic health-related expenses, according to a prospective cohort research by Bates and colleagues [1].…”

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