Hepatocellular carcinoma diagnosis and surveillance: Socioeconomic factors don’t seem to matter, unless you are an immigrant

Abstract

Evaluation of factors affecting hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is an important topic that has been neglected for several years. [1] El-Serag H.B. Rudolph K.L. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007; 132: 2557-2576 Abstract Full Text Full Text PDF PubMed Scopus (4451) Google Scholar This is surprising considering the heavy burden of HCC-related deaths and the beneficial impact in survival that can be achieved through early detection. [2] Singal A.G. Pillai A. Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med. 2014; 11 (e1001624) Crossref PubMed Scopus (492) Google Scholar Several studies this year have attempted to define factors associated with improved HCC surveillance. 3 Hernaez R. El-Serag H.B. Hepatocellular carcinoma surveillance: The road ahead. Hepatology. 2017; 65: 771-773 Crossref PubMed Scopus (18) Google Scholar , 4 Singal A.G. Tiro J.A. Marrero J.A. McCallister K. Mejias C. Adamson B. et al. Mailed outreach program increases ultrasound screening of patients with cirrhosis for hepatocellular carcinoma. Gastroenterology. 2017; 152 (e604): 608-615 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 5 Farvardin S. Patel J. Khambaty M. Yerokun O.A. Mok H. Tiro J.A. et al. Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis. Hepatology. 2017; 65: 875-884 Crossref PubMed Scopus (101) Google Scholar Those studies addressed the association of adherence to HCC surveillance programs in cirrhotic patients with patients’ knowledge, attitudes, and perceived barriers mainly through self-reporting surveys. They found an association between HCC surveillance participation and demographic variables that included age, sex, self-reported household income and level of education. Nonetheless, most studies have included self-reporting surveys, which can lead to biases that are difficult to account for. [5] Farvardin S. Patel J. Khambaty M. Yerokun O.A. Mok H. Tiro J.A. et al. Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis. Hepatology. 2017; 65: 875-884 Crossref PubMed Scopus (101) Google Scholar We retrospectively studied 233 cases of HCC at our institution in Minneapolis, Minnesota, using a census-based analysis. We addressed associations between household occupancy, education level and household income with the receipt of HCC screening in individuals diagnosed with HCC. The census-based analysis consisted of geocoding the home addresses of the individuals in the study, and then attaching the block group level census variables for household occupancy, education level and household income. A block group is the smallest geographic unit used by the United States Census bureau, measuring between 600 and 3,000 people. Household occupancy was categorized as 1 if the average occupancy in that block group was greater than or equal to 2. Education was categorized as 1 if the percent of high school graduates in that block group was less than the average percent of high school graduates in the state. Household income was categorized as 1 if the percent of households with incomes below the federal poverty level in that block group was higher than the average percent of households below the federal poverty level in the state. Socio-economic deprivation significantly impacts clinical management and survival in hepatocellular carcinomaJournal of HepatologyVol. 68Issue 3PreviewWe read with interest the contribution from Ashhab and colleagues in a recent edition of the Journal.1 The authors describe the findings of their study examining the association between socio-economic status (SES) and hepatocellular carcinoma (HCC) surveillance in individuals with chronic liver disease (CLD) in the United States. The study used geocoding software to link individual addresses with local census data. Whilst no link was found between SES and receiving surveillance, they noted a significant association between living in deprived areas and younger age of HCC diagnosis, which was also significantly impacted by lower education and income levels. Full-Text PDF Reply to: “Socio-economic deprivation significantly impacts clinical management and survival in hepatocellular carcinoma”Journal of HepatologyVol. 68Issue 3PreviewWe appreciate the correspondence of Mohammed et al. regarding our article on socioeconomic variables and hepatocellular carcinoma (HCC).1 Full-Text PDF