Significant Disparities in Hepatocellular Carcinoma Outcomes by Race/Ethnicity and Sociodemographic Factors.

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Hepatocellular carcinoma (HCC) disproportionately affects racial/ethnic minorities. We evaluated the impact of income and geography on racial/ethnic disparities across the HCC care cascade in the U.S. Using National Cancer Institute registry data spanning 2000-2020, adults with HCC were evaluated to determine race/ethnicity-specific differences in tumor stage at diagnosis, delays and gaps in treatment, and survival. Adjusted regression models evaluated predictors of HCC outcomes. Among 112,389 adults with HCC, cohort characteristics were as follows: 49.8% non-Hispanic White [NHW], 12.0% African American, 20.5% Hispanic, 16.5% Asian/Pacific Islander, 1.1% American Indian/Alaska Native. Compared to NHW patients, AA patients had lower odds of localized-stage HCC at diagnosis (aOR, 0.84), lower odds of HCC treatment receipt (aOR, 0.77), greater odds of treatment delays (aOR, 1.12), and significantly greater risk of death (aHR, 1.10). Compared to NHW from large-metro areas, AA from large metro areas had 8% higher mortality risk (aHR, 1.08) whereas AA from small-medium metro areas had 17% higher mortality risk (aHR, 1.17) (all P<0.05). Among a population-based cohort of U.S. adults with HCC, significant race/ethnicity-specific disparities across the HCC care continuum were observed. Lower household income and more rural geography among racial/ethnic minorities are also associated with disparities in HCC outcomes, particularly among AA patients. Our study shows that lower income and less urban/more rural geography among racial/ethnic minorities is also associated with disparities in HCC outcomes, particularly among AA patients with HCC. This contextualizes the complex relationship between sociodemographic factors and HCC outcomes through an intersectional lens.