Racial disparities among cancer patients present a varied and complex collection of outcomes, and this study provides data on how these disparities present at all stages in the clinical process.
In the United States, hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death. Significant disparities have been observed in cancer incidence among racial groups. This study, published in Cancer Epidemiology, provides an analysis of disparities among racial and ethnic groups as regards the incidence of HCC. The study used data from the National Inpatient Sample (NIS) between 2011 and 2016, using STROBE guidelines. The authors used multivariate logistic regression to examine the risk-adjusted associations between race and pre-treatment clinical presentation, surgical procedure allocation, and post-treatment hospital outcomes.
A total of 83,876 weighted HCC hospitalizations were used as data for this study. Clinical parameters were identified using ICD-9 and ICD-10 diagnosis and procedure codes. Participants were divided according to the NIS racial/ethnic categorization, and included Caucasian, African American, Hispanic, Asian or Pacific Islander, and Native American patients. An association between greater odds of hospitalization and Elixhauser Comorbidity Index > 4 was found among Native American, African American, and Hispanic population groups. The odds of having surgery were also found to be lower among African Americans and Hispanics, while significantly higher in the Asian or Pacific Islander group.
In-hospital mortality was highest among African Americans and Asian or Pacific Islanders, and postoperative complications were significantly lower for African Americans. After controlling for various parameters, significant but varied racial disparities were observed. These parameters varied significantly between pre-treatment, surgical procedure allocation, and post-treatment outcomes among all races included. The underlying reason for these disparities, which is needed to understand how to develop targeted interventions for these groups, is not yet known.
Chikovsky, L., Kutuk, T., Rubens, M., Balda, A. N., Appel, H., Chuong, M. D., Kaiser, A., Hall, M. D., Contreras, J., Mehta, M. P., & Kotecha, R. (2022). Racial disparities in clinical presentation, surgical procedures, and hospital outcomes among patients with hepatocellular carcinoma in the United States. Cancer Epidemiology, 82, 102317. https://doi.org/10.1016/j.canep.2022.102317