Original ArticleHepatologyRacial, Ethnic, and Socioeconomic Disparities in Treatment Delay Among Patients With Hepatocellular Carcinoma in the United States
Section snippets
Credit Authorship Contributions
Nikita Sandeep Wagle (Access to all data; Integrity of the data; Accuracy of the data analysis; Study concept and design; Acquisition, Analysis, and interpretation of the data; Drafting of the manuscript; Critical revision of the manuscript for important intellectual content)
Sulki Park (Acquisition, analysis, and interpretation of the data; Critical revision of the manuscript for important intellectual content)
David Washburn (Acquisition, analysis, and interpretation of the data; Critical
Data Source and Study Population
The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database is a population-based dataset providing information on diagnosis, survival, demographics, and health services utilization of patients with cancer from Medicare eligibility until death.17 We included Medicare beneficiaries aged ≥65 years who had diagnostically confirmed HCC (International Classification of Diseases [ICD] for Oncology, Third Edition, histology code 8170 and site code C22.0 for the liver with positive
Patient Characteristics
Of 13,874 patients with HCC, 8450 (60.9%) were treated within 12 months of diagnosis (Supplementary Figure 1). The median age was 73 years, and more than two-thirds (67.2%) were male. The racial and ethnic composition of the cohort was 68.1% white, 7.4% Black, 13.4% Asian, and 4.0% Hispanic patients. Most patients resided in low-poverty neighborhoods (48.2%) and in metropolitan areas with more than 1 million people (62.7%). The most common liver disease etiology was MAFLD (36.4%), followed by
Discussion
In this population-based sample, we found that nearly 1 in 7 patients with HCC experience treatment delays exceeding 3 months. Several sociodemographic factors were associated with treatment delay; Black patients and those living in moderate and high poverty neighborhoods were more likely to experience treatment delays than white patients and those living in low poverty neighborhoods, respectively. These findings are notable given the association between treatment delay and worse survival,
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Conflicts of interest This author discloses the following: Amit Singal has served as a consultant or on advisory boards for Bayer, Eisai, BMS, Exelixis, Genentech, AstraZeneca, FuijFilm Medical Sciences, Exact Sciences, Roche, Glycotest, GRAIL, and TARGET RWE. The remaining authors disclose no conflicts.
Funding This work was supported by the Population Informatics Lab, the Texas Virtual Data Library (ViDaL) at Texas A&M University, Cancer Prevention Research Institute of Texas (CPRIT) RP200633, and the National Institutes of Health R01 MD012565 and R01CA256977.
Data sharing statement The data underlying this article cannot be shared publicly because the National Cancer Institute does not permit others to use the data except for collaborators at our institution involved with this research as described in our research proposal. However, this data can be obtained through https://healthcaredelivery.cancer.gov/seermedicare/obtain/ by paying the cost mentioned.
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Authors share co-senior authorship.