Racial and Geographic Disparities in Hepatocellular Carcinoma Outcomes

Ricardo A. Franco, Yunhua Fan, Stephanie Jarosek, Sejong Bae, James Galbraith

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Introduction: Hepatocellular carcinoma disproportionately affects minorities. Southern states have high proportions of black populations and prevalence of known risk factors. Further research is needed to understand the role of southern geography in hepatocellular carcinoma disparities. This paper examined racial disparities in hepatocellular carcinoma incidence, demographics, tumor characteristics, receipt of treatment, and all-cause mortality in southern and non-southern cancer registries. Methods: Surveillance Epidemiology and End Results data were probed in 2015 to identify 43,868 patients diagnosed with hepatocellular carcinoma from 2000 to 2012 (5,455 in southern registries [Atlanta, Louisiana, and Rural and Greater Georgia]). Results: Southern registries showed steeper increases of age-adjusted hepatocellular carcinoma incidence (from 2.89 to 5.29cases/100,000 people) versus non-southern areas (from 3.58 to 5.54cases/100,000 people). Blacks were over-concentrated in southern registries (32% vs 10%). Compared with whites, blacks were significantly younger at diagnosis, more likely diagnosed with metastasis, and less likely to receive surgical therapies in both registry groups. After adjustment, blacks had a significantly higher risk of all-cause mortality compared with whites in southern (hazard ratio=1.10, p=0.007) and non-southern areas (hazard ratio=1.08, p<0.001). For overall populations, southern registries had higher risk of all-cause mortality versus non-southern registries (hazard ratio=1.13, p<0.001). Conclusions: Age-adjusted incidence rates of hepatocellular carcinoma are plateauing overall, but are still rising in southern areas. Race and geography had independent associations with all-cause mortality excess risk among patients with hepatocellular carcinoma. Further studies are needed to understand the root causes of potential mortality risk excess among overall populations with hepatocellular carcinoma living in the South. Supplement information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Original languageEnglish (US)
Pages (from-to)S40-S48
JournalAmerican journal of preventive medicine
Volume55
Issue number5
DOIs
StatePublished - Nov 2018

Bibliographical note

Funding Information:
This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy, which is sponsored by the National Institutes of Health.

Funding Information:
Publication of this article was supported by a grant from the National Institute on Minority Health and Health Disparities, National Institutes of Health [grant number U54MD008620]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.

Publisher Copyright:
© 2018 Elsevier Ltd

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