Impact of Social Determinants of Health (SDH) on Outcomes in Patients with Hepatocellular Carcinoma (HCC)

Abstract

<h3>Purpose/Objective(s)</h3> SDH are non-clinical factors that impact health outcomes. There are limited data on the intersection of these sociodemographic factors and disparities in outcomes in HCC. The goal of this study is to analyze the impact of SDH on survival of patients (pts) diagnosed with HCC. <h3>Materials/Methods</h3> The National Cancer Database was queried for pts diagnosed with HCC between 2004-2017. Demographic and clinical characteristics were displayed with means for continuous variables and frequencies for categorical variables. Cox proportional hazard regression was used to model time to death with statistical significance being defined as two-sided alpha < 0.05. Variables included in multivariate analysis (MVA) included: stage, age, race, sex, ethnicity, % no high school degree, income, urban/rural, insurance, year of diagnosis (YOD), Charlson-Deyo (CD) score, facility type. These analyses were performed using a data management and decision management software. <h3>Results</h3> Pts characteristics are presented in table 1. The cohort included 185,570 pts with a median OS of 12.3 months. The majority of pts were male (76.2%), white (73.5%), non-Hispanic (12.3%), and treated at an academic center (53.5%). 22.8% lived in areas with a median income < $40,227 while 27.4% lived where the median income was > $63,333. On MVA, clinical factors such as earlier stage, female sex, recent YOD, and CD score of 0 were associated with improved overall survival (all p<0.001). SDH variables associated with improved survival included Hispanic ethnicity, higher income, treatment at an academic center and private insurance (p < 0.05 or less). Asian pts had a better survival than whites (p < 0.001), but Black pts did not (p = 0.97). Pts with CD score of 3+ have worse survival than those with score of 0 (p<0.001). Pts that lived in counties with a population of 2,500-1 million people had worse survival than those that lived in cities with a population >1 million (p < 0.001). Education was not found to be statistically significant. <h3>Conclusion</h3> SDH played an important role in survival of pts with HCC. Further research is needed to investigate the root causes of cancer inequities and develop resources dedicated to reducing income disparities, improving insurance coverage, and increasing access of care for pts diagnosed with HCC.