Socioeconomic Factors Affect Age of Onset of Hepatocellular Carcinoma

Abstract

INTRODUCTION: Hepatocellular carcinoma (HCC) is an aggressive malignancy with a heterogeneous disease process and variable clinical presentation. Patient outcomes vary based on differential tumor biology, demographics, clinicopathologic variables, hospital-system and treatment-related factors. Our study aimed to investigate the socioeconomic factors associated with early-onset HCC. METHODS: We queried the Surveillance, Epidemiology, and End Results (SEER) database for adult patients with HCC from 2007 to 2016. Clinicopathologic data were correlated to factors associated with age at diagnosis. Logistic regression with univariate/multivariate linear regression was performed to determine factors associated with early-onset HCC. RESULTS: Overall, 36,982 patients were identified in the database. There were significant differences between the 2 patient cohorts. There were a disproportionate number of racial/ethnic minorities diagnosed with early-onset HCC (p < 0.05). Early-onset HCC patients were more likely to be uninsured or have Medicaid insurance (p < 0.05) and have lower education levels (p < 0.05). Early-onset HCC also presented at advanced stages (stage III). Early-onset HCC was more likely to undergo upfront resection compared with late-onset group (p < 0.05). Socioeconomic factors such as race/ethnicity, insurance, and education level were associated with age of HCC onset. CONCLUSION: Socioeconomic factors affect the age of HCC onset. Patients of lower socioeconomic status (SES) are more likely to present with early-onset HCC (age <45). HCC disproportionately affects disadvantaged patients. Lower SES patients are more likely to receive hepatic resection or definitive chemotherapy compared to higher SES patients who are more likely to receive targeted local-regional therapy. Identifying specific socioeconomic disparities can lead to more targeted screening programs for high-risk individuals to improve HCC treatment outcomes.