Disparities in Hepatocellular Carcinoma Stage at Diagnosis and Initial Treatment
Previous research suggests that hepatocellular carcinoma (HCC) health disparities affect Asian Americans, a highly heterogeneous racial/ethnic population consisting of many subgroups. The purpose of this study is to explore the association of Asian American race/ethnicity with stage at presentation and initial treatment among patients diagnosed with HCC in California, while controlling for sociodemographic and clinical characteristics. To research racial/ethnic differences in stage at diagnosis and treatment, we conducted a retrospective, cohort study using Surveillance, Epidemiology and End Results Program (SEER) data from 8,484 Californians of Asian and White race/ethnicity, aged 18 to 64, and diagnosed with HCC between 2007-2014. Filipino (Odds Ratio: 1.691, 95% Confidence Interval [95%CI]: 1.339-2.137) and Korean (OR: 1.339, 95%CI: 1.003-1.788) race/ethnicity, earlier time period of diagnosis 2007-2010 (OR: 1.228, 95%CI: 1.126-1.340), male sex (OR: 1.374, 95%CI: 1.224-1.542), Greater California (OR: 1.224, 95%CI: 1.091-1.374) and Los Angeles (OR: 1.270, 95%CI: 1.112-1.450) residence, and patients with public insurance (OR: 1.249, 95%CI: 1.135-1.375) and no insurance (OR: 2.193, 95%CI: 1.783-2.698) disproportionately presented at regional/distant stage of disease. In addition, receipt of treatment was significantly higher among Chinese (OR: 1.760, 95%CI: 1.421-2.180), Korean (OR: 1.916, 95%CI: 1.373-2.675), Vietnamese (OR: 1.772, 95%CI: 1.418-2.215) racial/ethnic subgroups, patients with localized stage (OR: 4.075, 95%CI: 3.622-4.583), and patients in the earlier time period of diagnosis 2007-2010 (OR: 1.123, 95%CI: 1.010-1.248). Age group 50-64 (OR: 0.830, 95%CI: 0.710-0.971), male sex (OR: 0.720, 95%CI: 0.630-0.822), single status (OR: 0.725, 95%CI: 0.648-0.812), and patients with public insurance (OR: 0.454, 95%CI: 0.401-0.513) and no insurance (OR: 0.171, 95%CI: 0.114-0.256) were associated with reduced odds of receiving treatment. After adjustment for time period of diagnosis, age group, sex, geographic region, marital status, and health insurance status, disparities in the stage at diagnosis and receipt of treatment remained. Our hypothesis that stage at diagnosis and receipt of initial treatment would differ by Asian American race/ethnicity was verified. Understanding disparities in HCC staging and treatment can help address gaps in care for specific populations and improve public health programs and policies through targeted focus on early detection and intervention in high at-risk populations.
Recommended CitationAdeeb, Saema, "Disparities in Hepatocellular Carcinoma Stage at Diagnosis and Initial Treatment" (2017). Master of Public Health Thesis and Capstone Presentations. Presentation 237.