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Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma

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Abstract

Background

Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status.

Aims

Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA.

Study

We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups.

Results

Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival.

Conclusions

Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients.

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Funding

Dr. Singal was supported in part by NIH RO1 MD12565. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.

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Author notes

  1. Amit G. Singal and Neehar D. Parikh have contributed equally to this manuscript and are co-senior authors.

Authors and Affiliations

  1. Department of Internal Medicine, Loyola University Medical Center, 2160 S, 1st Avenue, Maywood, IL, 60153, USA

    Steve Scaglione & Allyce Caines

  2. Department of Public Health Sciences, Loyola University Medical Center, Maywood, IL, USA

    William Adams

  3. Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA

    Amit G. Singal

  4. Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA

    Amit G. Singal

  5. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA

    Sahil Mittal

  6. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Pauline Devlin & Neehar D. Parikh

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  1. Steve Scaglione
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Contributions

SS was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of manuscript for important intellectual content, and study supervision. He is the guarantor of the article. WA was involved in data analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. AC was involved in study concept and design, acquisition of data, and critical revision of manuscript for important intellectual content. PD was involved in acquisition of data and critical revision of manuscript for important intellectual content. SM was involved in study concept and design, acquisition of data, interpretation of data, critical revision of manuscript for important intellectual content, and study supervision. AS was involved in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript for important intellectual content, and study supervision. NP was involved in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript for important intellectual content, and study supervision.

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Correspondence to Steve Scaglione.

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Scaglione, S., Adams, W., Caines, A. et al. Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma. Dig Dis Sci 65, 1669–1678 (2020). https://doi.org/10.1007/s10620-019-05890-2

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  • DOI: https://doi.org/10.1007/s10620-019-05890-2

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