November 18, 2020
2 min read
Patients with hepatocellular carcinoma who live in rural regions or lower-income households had more advanced disease at diagnosis and higher disease-related mortality than other patients, according to study results published in Cancer.
“[Although] our study could not specifically investigate the reasons for the worse liver cancer outcomes, we hypothesize that patients living in more rural regions and among lower-income households likely experience health care disparities leading to suboptimal access to high-quality liver disease care, including timely receipt of liver cancer surveillance and access to liver disease specialists,” Robert J. Wong, MD, MS, assistant clinical professor at University of California, San Francisco, said in a press release. “Our study highlights the need to focus on understanding the drivers of poor liver cancer outcomes among underserved and vulnerable populations … so that targeted quality improvement interventions can more specifically address the needs of these populations.”
Incidence of HCC has started to plateau in the United States with the success of treatments for hepatitis C infection. Emerging contributions of nonalcoholic fatty liver disease and alcoholic cirrhosis to the development of HCC remain a concern, researchers noted. Moreover, certain populations may have limited access to therapies that can reduce liver disease progression to cirrhosis and lead to reductions in HCC incidence.
Wong and colleagues used SEER data from 2004 to 2017 to retrospectively examine HCC incidence and outcomes among U.S. adults, focusing on the impact of rural geography and household income on tumor stage and mortality.
Researchers identified 83,237 adults with HCC during the period. More than three-quarters (76.7%) were men, 63.7% were aged 60 years or older and 50% were white. About half (49.1%) had localized disease at diagnosis, whereas 14.4% had distant-stage disease.
Researchers reported HCC incidence per 100,000 persons and compared it using z-statistics. They used multivariate logistic regression to evaluate tumor stage at diagnosis and the Kaplan-Meier and multivariate Cox proportional hazards methods to study HCC mortality.
Results showed a significant increase in HCC incidence from 2004 to 2014 (P < .05), followed by a decrease from 2014 to 2017 (annual percent change [APC], 2.47, P < .05).
Incidence plateaued during the study period for most groups with the exception of American Indians/Alaska Natives (APC, 4.17; P < .05) and patients with annual household income of less than $40,000 (2006-2014 APC, 2.8%; P < .05).
Patients in more rural regions had higher odds of advanced-stage HCC diagnosis than patients in large metropolitan areas with a population of more than 1 million (OR = 1.1; 95% CI, 1-1.2), as well as higher mortality (HR = 1.05; 95% CI, 1.01-1.08).
Patients with HCC who had an annual income of less than $40,000 had higher odds of advanced-stage HCC (OR = 1.15; 95% CI, 1.01-1.32) and higher mortality (HR = 1.23; 95% CI, 1.16-1.31) than patients with an annual income $70,000 or greater.
“We hope that our findings will raise greater awareness of challenges and limited resources that contribute to suboptimal liver disease care experienced by patients from low-income and rural households,” Wong said in the press release.