2842 Do Socioeconomic Factors Really Have an Impact on Early Detection of Hepatocellular Carcinoma and Colorectal Cancer?

Abstract

INTRODUCTION: Improving surveillance in Hepatocellular Carcinoma (HCC) and Colorectal Cancer (CRC) is an important topic in the field of Gastroenterology and Oncology due to significant benefit associated with early detection and better outcomes. Multiple studies have been undertaken to assess association between socioeconomic status of the population and its impact on HCC/CRC screening and survival after diagnosis. Most of these studies used self-reporting surveys and faced limitations due to reporting bias. We aimed to assess the relevance of socioeconomic factors in diagnosis of HCC and CRC in Jackson County, Kansas City, Missouri by means of a census-based survey. METHODS: We retrospectively studied 190 HCC and 690 CRC cases at our institution using a census-based analysis, which consisted of geocoding home addresses of patients and then attaching block level census variables for household occupancy, education level and household income. Survival was assessed using time of last contact at our facility. Statistical analysis was performed using Cox proportional hazard model and ordinal logistic regression. RESULTS: We did not find a statistically significant association between socioeconomic factors and adherence to surveillance guidelines for HCC and CRC leading to improved overall survival. Variables that were analyzed included high school education or better (P = 0.5), four-person households with one or more workers (P = 0.08) and income less than 25 thousand dollars (P = 0.58). Study results were risk adjusted for age, race and gender. Separate ordinal logistic regression analysis was done to also adjust for stage at time of eventual cancer diagnosis, no statistically significant result was obtained. CONCLUSION: Our study showed no association between socioeconomic variables and participation in HCC or CRC surveillance. The study is limited by a relatively small sample size confined to local patients seen at our institution. Multicenter census-based surveys and meta-analyses need to be conducted to determine whether socioeconomic factors really have an appreciable impact on early screening and detection of HCC and CRC.