Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012

doi:10.3748/wjg.v22.i38.8584

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World J Gastroenterol. Oct 14, 2016; 22(38): 8584-8595
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8584

Table 1 Demographic and tumor characteristics by race/ethnic groups among patients with hepatocellular carcinoma in California, 1988-2012 (n = 33270)

	American Indian/Alaska Native		Black		Cambodian		Chinese		Filipino		Hawai`ian/Pacific Islander		Hispanic		Japanese		Korean		Laotian/Hmong		Other Asian		South Asian		Thai		Vietnamese		White
	(n = 281)		(n = 2609)		(n = 233)		(n = 2723)		(n = 1479)		(n = 172)		(n = 8500)		(n = 658)		(n = 1099)		(n = 244)		(n = 214)		(n = 190)		(n = 95)		(n = 2063)		(n = 12710)
	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Age at diagnosis
< 50	47	16.7	323	12.4	63	27.0	437	16.0	219	14.8	30	17.4	1170	13.8	30	4.6	172	15.7	65	26.6	44	20.6	13	6.8	29	30.5	326	15.8	1181	9.3
50-59	102	36.3	936	35.9	78	33.5	579	21.3	324	21.9	58	33.7	2604	30.6	116	17.6	284	25.8	62	25.4	58	27.1	44	23.2	27	28.4	533	25.8	3705	29.2
60-69	90	32.0	833	31.9	57	24.5	744	27.3	339	22.9	46	26.7	2424	28.5	219	33.3	346	31.5	72	29.5	59	27.6	65	34.2	22	23.2	596	28.9	3640	28.6
70-79	34	12.1	391	15.0	19	8.2	689	25.3	403	27.2	30	17.4	1657	19.5	206	31.3	233	21.2	31	12.7	44	20.6	45	23.7	13	13.7	471	22.8	2831	22.3
≥ 80	8	2.8	126	4.8	16	6.9	274	10.1	194	13.1	8	4.7	645	7.6	87	13.2	64	5.8	14	5.7	9	4.2	23	12.1	-¹	-¹	137	6.6	1353	10.6
Gender
Male	214	76.2	1971	75.6	182	78.1	2078	76.3	1111	75.1	138	80.2	6368	74.9	285	43.3	761	69.2	188	77.0	155	72.4	138	72.6	73	76.8	1622	78.6	9762	76.8
Female	67	23.8	638	24.4	51	21.9	645	23.7	368	24.9	34	19.8	2132	25.1	373	56.7	338	30.8	56	23.0	59	27.6	52	27.4	22	23.2	441	21.4	2948	23.2
Socioeconomic status (SES)
1 - Low SES	75	26.7	867	33.2	113	48.5	377	13.8	204	13.8	30	17.4	2975	35.0	49	7.4	176	16.0	129	52.9	31	14.5	13	6.8	12	12.6	316	15.3	1599	12.6
2	82	29.2	586	24.8	42	18.0	428	15.7	286	19.3	42	24.4	2248	26.4	118	17.9	184	16.7	68	27.9	38	17.8	32	16.8	31	32.6	541	26.2	2512	19.8
3	72	25.6	483	18.5	33	14.2	488	17.9	367	24.8	40	23.3	1621	19.1	153	23.3	188	17.1	26	10.7	42	19.6	38	20.0	20	21.1	481	23.3	2977	23.4
4	36	12.8	409	15.7	26	11.2	660	24.2	402	27.2	34	19.8	1054	12.4	164	24.9	255	23.2	19	7.8	63	29.4	60	31.6	18	18.9	400	19.4	2942	23.1
5 - High SES	16	5.7	203	7.8	19	8.2	770	28.3	220	14.9	26	15.1	602	7.1	174	26.4	296	26.9	-¹	-¹	40	18.7	47	24.7	14	14.7	325	15.8	2680	21.1
Region
San Francisco- Oakland	44	15.7	753	28.9	31	13.3	1482	54.4	517	35.0	62	36.0	1329	15.6	171	26.0	178	16.2	28	11.5	79	36.9	57	30.0	14	14.7	701	34.0	2637	20.7
Central California	78	27.8	335	12.8	24	10.3	78	2.9	109	7.4	21	12.2	2129	25.0	65	9.9	67	6.1	75	30.7	39	18.2	36	18.9	11	11.6	104	5.0	2705	21.3
Northern California	100	35.6	323	12.4	38	16.3	152	5.6	126	8.5	22	12.8	635	7.5	92	14.0	34	3.1	85	34.8	13	6.1	40	21.1	7	7.4	116	5.6	2578	20.3
San Diego- Imperial-Orange	33	11.7	206	7.9	22	9.4	173	6.4	263	17.8	28	16.3	1258	14.8	112	17.0	197	17.9	43	17.6	19	8.9	29	15.3	8	8.4	760	36.8	2208	17.4
Los Angeles	26	9.3	992	38.0	118	50.6	838	30.8	464	31.4	39	22.7	3149	37.0	218	33.1	623	56.7	13	5.3	64	29.9	28	14.7	55	57.9	382	18.5	2582	20.3
Stage at diagnosis
Local	109	38.8	987	37.8	96	41.2	1179	43.3	584	39.5	73	42.4	3825	45.0	288	43.8	450	40.9	71	29.1	102	47.7	84	44.2	38	40.0	947	45.9	5355	42.1
Regional	85	30.2	668	25.6	61	26.2	606	22.3	384	26.0	43	25.0	2010	23.6	142	21.6	267	24.3	52	21.3	48	22.4	53	27.9	22	23.2	498	24.1	2988	23.5
Remote	62	22.1	682	26.1	55	23.6	645	23.7	362	24.5	44	25.6	1812	21.3	149	22.6	242	22.0	88	36.1	49	22.9	40	21.1	24	25.3	437	21.2	2905	22.9
Unstaged	25	8.9	272	10.4	21	9.0	293	10.8	149	10.1	12	7.0	853	10.0	79	12.0	140	12.7	33	13.5	15	7.0	13	6.8	11	11.6	181	8.8	1462	11.5
Time period of diagnosis
1988-1992	9	3.2	217	8.3	22	9.4	334	12.3	161	10.9	14	8.1	557	6.6	84	12.8	114	10.4	29	11.9	9	4.2	12	6.3	7	7.4	128	6.2	1257	9.9
1993-1997	14	5.0	319	12.2	30	12.9	435	16.0	195	13.2	25	14.5	809	9.5	108	16.4	178	16.2	41	16.8	11	5.1	15	7.9	12	12.6	271	13.1	1681	13.2
1998-2002	49	17.4	472	18.1	45	19.3	543	19.9	304	20.6	32	18.6	1461	17.2	139	21.1	267	24.3	56	23.0	51	23.8	29	15.3	21	22.1	429	20.8	2252	17.7
2003-2007	88	31.3	683	26.2	61	26.2	695	25.5	408	27.6	41	23.8	2340	27.5	166	25.2	270	24.6	49	20.1	50	23.4	61	32.1	16	16.8	575	27.9	3208	25.2
2008-2012	121	43.1	918	35.2	75	32.2	716	26.3	411	27.8	60	34.9	3333	39.2	161	24.5	270	24.6	69	28.3	93	43.5	73	38.4	39	41.1	660	32.0	4312	33.9
Type of surgery
None	238	84.7	2214	84.9	198	85.0	2007	73.7	1220	82.5	138	80.2	7062	83.1	491	74.6	805	73.2	230	94.3	158	73.8	145	76.3	75	78.9	1536	74.4	10117	79.6
Local	20	7.1	150	5.7	13	5.6	184	6.8	60	4.1	10	5.8	550	6.5	58	8.8	83	7.6	7	2.9	16	7.5	18	9.5	-¹	-¹	194	9.4	925	7.3
Resection/transplant	23	8.2	245	9.4	22	9.4	532	19.5	199	13.5	24	14.0	888	10.4	109	16.6	211	19.2	7	2.9	40	18.7	27	14.2	16	16.8	333	16.1	1668	13.1

¹Less than 5 cases. χ², P < 0.0001 for racial/ethnic differences in all variables tabulated.

Table 2 Factors associated with receipt of surgical treatment for hepatocellular carcinoma in California, 1988-2012 (n = 33270)

	Receipt of surgical treatment
	Unadjusted OR	95%CI	Adjusted¹ OR	95%CI
American Indian/Alaska Native	0.71^a	0.51-0.98^a	0.66^a	0.46-0.93^a
Black	0.70^a	0.62-0.78^a	0.76^a	0.67-0.86^a
Cambodian	0.69^a	0.48-0.99^a	0.65^a	0.45-0.96^a
Chinese	1.39^a	1.27-1.53^a	1.58^a	1.42-1.77^a
Filipino	0.83^a	0.72-0.95^a	0.92	0.79-1.07
Hawai`ian/Pacific Islander	0.96	0.66-1.40	0.94	0.62-1.40
Hispanic	0.79^a	0.74-0.85^a	0.78^a	0.72-0.84^a
Japanese	1.33^a	1.11-1.59^a	1.41^a	1.15-1.72^a
Korean	1.43^a	1.24-1.64^a	1.45^a	1.24-1.70^a
Laotian/Hmong	0.24^a	0.14-0.41^a	0.30^a	0.17-0.53^a
Other Asian	1.38^a	1.02-1.88^a	1.27	0.91-1.78
South Asian	1.21	0.86-1.70	1.13	0.78-1.63
Thai	1.04	0.63-1.71	1.04	0.61-1.78
Vietnamese	1.34^a	1.20-1.49^a	1.26^a	1.12-1.42^a
White	1.00		1.00
Age at diagnosis
< 50			1.00
50-59			0.83^a	0.76-0.92^a
60-69			0.76^a	0.69-0.84^a
70-79			0.47^a	0.42-0.52^a
≥ 80			0.20^a	0.17-0.24^a
Gender
Female			1.00
Male			0.82^a	0.77-0.88^a
Socioeconomic Status
1 - Low SES			1.00
2			1.25^a	1.13-1.37^a
3			1.29^a	1.17-1.42^a
4			1.65^a	1.49-1.82^a
5 - High SES			1.84^a	1.66-2.05^a
Region
Los Angeles			1.00
San Francisco-Oakland			0.81^a	0.74-0.88^a
Central California			0.96	0.87-1.05
Northern California			1.09	0.98-1.20
San Diego-Imperial-Orange			1.34^a	1.22-1.47^a
Stage at diagnosis: 1988-1992
Remote			1.00
Regional			3.30^a	2.29-4.75^a
Local			8.28^a	6.09-11.26^a
Unstaged			0.27^a	0.15-0.48^a
Stage at diagnosis: 1993-1997
Remote			1.00
Regional			2.88^a	2.02-4.11^a
Local			8.81^a	6.79-11.43^a
Unstaged			0.47^a	0.27-0.79^a
Stage at diagnosis: 1998-2002
Remote			1.00
Regional			2.61^a	2.01-3.40^a
Local			8.07^a	6.49-10.04^a
Unstaged			0.78	0.52-1.17
Stage at diagnosis: 2003-2007
Remote			1.00
Regional			4.44^a	3.44-5.73^a
Local			12.97^a	10.16-16.56^a
Unstaged			0.93	0.58-1.49
Stage at diagnosis: 2008-2012
Remote			1.00
Regional			4.50^a	3.43-5.92^a
Local			13.6^a	10.48-17.66^a
Unstaged			1.12	0.68-1.87
Time period of diagnosis: remote stage tumors
1988-1992			1.00
1993-1997			0.75	0.53-1.06
1998-2002			0.89	0.64-1.23
2003-2007			0.83	0.58-1.17
2008-2012			0.59^a	0.41-0.85^a

¹Adjusted for all other factors presented in the table using multivariable logistic regression.

^aP < 0.05. Time period X stage interaction P = 0.0014.

Table 3 Factors associated with survival from hepatocellular carcinoma in California, 1988-2012 (n = 33270)

	Cause-specific survival				All cause survival
	Unadjusted HR	95%CI	Adjusted¹ HR	95%CI	UnadjustedHR	95%CI	Adjusted¹ HR	95%CI
American Indian/ Alaska Native	0.92	0.79-1.07	0.90	0.77-1.04	0.94	0.82-1.07	0.91	0.80-1.04
Black	1.12^a	1.06-1.18^a	1.07^a	1.01-1.13^a	1.12^a	1.07-1.17^a	1.06^a	1.01-1.11^a
Cambodian	1.38^a	1.18-1.60^a	1.35^a	1.16-1.58^a	1.31^a	1.15-1.51^a	1.27^a	1.11-1.46^a
Chinese	0.81^a	0.77-0.86^a	0.82^a	0.77-0.86^a	0.75^a	0.72-0.79^a	0.76^a	0.72-0.79^a
Filipino	0.95	0.88-1.01	0.84^a	0.78-0.90^a	0.98	0.92-1.04	0.88^a	0.83-0.93^a
Hawai`ian/Pacific Islander	0.95	0.78-1.15	0.98	0.81-1.19	0.97	0.82-1.14	1.00	0.85-1.18
Hispanic	0.91^a	0.88-0.95^a	0.91^a	0.88-0.94^a	0.98	0.95-1.01	0.95^a	0.92-0.99^a
Japanese	0.95	0.86-1.04	0.93	0.84-1.02	0.88^a	0.81-0.96^a	0.86^a	0.79-0.94^a
Korean	0.87^a	0.80-0.93^a	0.90^a	0.83-0.97^a	0.80^a	0.74-0.85^a	0.82^a	0.76-0.88^a
Laotian/Hmong	1.91^a	1.65-2.21^a	1.50^a	1.29-1.73^a	1.74^a	1.52-1.98^a	1.37^a	1.20-1.57^a
Other Asian	0.80^a	0.67-0.96^a	0.98	0.82-1.17	0.80^a	0.68-0.93^a	0.96	0.82-1.12
South Asian	0.91	0.75-1.09	0.88	0.74-1.06	0.93	0.79-1.09	0.91	0.78-1.06
Thai	1.00	0.77-1.29	1.08	0.84-1.40	0.96	0.77-1.21	1.04	0.82-1.30
Vietnamese	0.83^a	0.79-0.89^a	0.85^a	0.80-0.90^a	0.79^a	0.75-0.84^a	0.80^a	0.76-0.84^a
White	1.00		1.00		1.00		1.00
Age at diagnosis
< 50			1.00				1.00
50-59			1.01	0.96-1.06			1.04	1.00-1.09
60-69			1.06^a	1.01-1.11^a			1.08^a	1.04-1.13^a
70-79			1.29^a	1.23-1.35^a			1.29^a	1.24-1.35^a
≥ 80			1.54^a	1.45-1.64^a			1.57^a	1.49-1.65^a
Gender
Female			1.00				1.00
Male			1.10^a	1.07-1.14^a			1.09^a	1.06-1.12^a
Socioeconomic status
1 - Low SES			1.00				1.00
2			0.95^a	0.92-0.99^a			0.94^a	0.91-0.98^a
3			0.91^a	0.88-0.95^a			0.90^a	0.87-0.94^a
4			0.88^a	0.84-0.92^a			0.86^a	0.83-0.89^a
5 - High SES			0.81^a	0.77-0.85^a			0.79^a	0.75-0.82^a
Region
Los Angeles			1.00				1.00
San Francisco- Oakland			1.03	0.99-1.07			1.00	0.97-1.03
Central California			1.06^a	1.02-1.11^a			1.07^a	1.03-1.11^a
Northern California			1.14^a	1.08-1.19^a			1.08^a	1.04-1.12^a
San Diego- Imperial-Orange			1.09^a	1.05-1.14^a			1.08^a	1.04-1.13^a
Stage at diagnosis
Remote			1.00				1.00
Regional			0.70^a	0.67-0.73^a			0.71^a	0.69-0.74^a
Local			0.39^a	0.38-0.41^a			0.44^a	0.43-0.46^a
Unstaged			0.76^a	0.72-0.79^a			0.77^a	0.74-0.80^a
Time period of diagnosis
1988-1992			1.00				1.00
1993-1997			0.86^a	0.82-0.91^a			0.90^a	0.86-0.95^a
1998-2002			0.75^a	0.71-0.79^a			0.77^a	0.74-0.81^a
2003-2007			0.69^a	0.66-0.73^a			0.72^a	0.68-0.75^a
2008-2012			0.54^a	0.51-0.57^a			0.57^a	0.54-0.60^a
Type of surgery
None			1.00				1.00
Local			0.40^a	0.38-0.43^a			0.43^a	0.41-0.46^a
Resection or transplant			0.26^a	0.25-0.28^a			0.29^a	0.28-0.31^a

¹Adjusted for all other factors presented in the table using Cox proportional hazards regression models.

^aP < 0.05.

Citation: Stewart SL, Kwong SL, Bowlus CL, Nguyen TT, Maxwell AE, Bastani R, Chak EW, Chen Jr MS. Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012. World J Gastroenterol 2016; 22(38): 8584-8595
URL: https://www.wjgnet.com/1007-9327/full/v22/i38/8584.htm
DOI: https://dx.doi.org/10.3748/wjg.v22.i38.8584