Socioeconomic And Survival Differences Among Minorities With Hepatocellular Carcinoma In Florida
Received 16 April 2019
Accepted for publication 10 October 2019
Published 15 November 2019 Volume 2019:6 Pages 167—181
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Dr Ahmed O. Kaseb
Patricia D Jones,1,2 Andrew R Scheinberg,3 Valery Muenyi,3 Joselin Gonzalez-Diaz,1 Paul M Martin,1,2 Erin Kobetz2,4
1Department of Medicine, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, Florida, USA; 2Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA; 3Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA; 4Department of Medicine, Division of Computational Medicine and Population Health, University of Miami Miller School of Medicine, Miami, Florida, USA
Correspondence: Patricia D Jones
Department of Medicine, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, 1120 NW 14 th Street, Miami, FL 33136, USA
Tel +1 305 243-0779
Background: Disparities in hepatocellular carcinoma (HCC) have been partly attributed to low socioeconomic status among minorities. We investigated associations between race, socioeconomic characteristics, geographic characteristics and survival in HCC patients in Florida.
Methods: Using the Florida Cancer Data System (FCDS), we analyzed HCC cases diagnosed between 1/1/2004 and 12/31/2013. To ascertain population-level socioeconomic characteristics, we linked FCDS to the 2010–2014 US Census American Community Survey and the 2013 Florida Behavioral Risk Factor Surveillance System. We also estimated patient distance to liver transplant and academic cancer centers. Using Cox proportional hazards, we modeled the association between race and survival.
Results: Of 10,852 patients, 13.1% were Black, 67.1% White, 15.7% Hispanic, and 3.2% Asian. At diagnosis, Blacks were younger with more extensive disease, p <0.001. Transplants were performed in 9.3% of Hispanics, 7.5% of Whites, 5.8% of Asians and 4.2% of Blacks, p <0.001. Median survival was longest in Hispanics and shortest in Blacks, p<0.001 When adjusted for gender, age, payer, SEER stage, surgery type, and receipt of treatment, Blacks had a 17% increased risk of death [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07–1.29] and Whites a 9% increased risk of death [HR 1.09, 95% CI 1.02–1.17] compared to Hispanics. As a group, Hispanics lived closest to any transplant or academic cancer center, p <0.001. Neighborhood poverty level was highest where Hispanic patients lived, p <0.001.
Conclusion: Though socioeconomic differences may contribute to disparities, Hispanics survived longer than Blacks and Whites in Florida despite living in the most socioeconomically depressed neighborhoods. Increased access to transplant likely contributed to improved survival. Additional research is needed to identify which individual socioeconomic and geographic determinants contribute most to disparities.
Keywords: racial disparities, hepatocellular carcinoma, geographic disparities
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