Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2018; 10(11): 849-855
Published online Nov 27, 2018. doi: 10.4254/wjh.v10.i11.849
African Americans are less likely to receive curative treatment for hepatocellular carcinoma
Lindsay A Sobotka, Alice Hinton, Lanla F Conteh
Lindsay A Sobotka, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Alice Hinton, Division of Biostatistics, College of Public Health, The Ohio State University, OH 43210, United States
Lanla F Conteh, Department of Gastroenterology and Hepatology, The Ohio State Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: All authors helped to perform the research; Sobotka LA conceived and designed the study, interpreted the data, drafted the article, and approved the final version of the article to be published; Hinton A acquired data, analyzed data, made critical revisions related to important intellectual content of the manuscript, and approved the final article to be published; Conteh LF conceived and designed the study, interpreted data, drafted the article, made critical revisions related to important intellectual content of the manuscript, and approved the final version of the article to be published.
Institutional review board statement: This research is not a clinical trial and did not require institutional review board approval through The Ohio State University given the de-identified nature of this database.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lanla F Conteh, Doctor, MD, MPH, Department of Gastroenterology and Hepatology, The Ohio State Wexner Medical Center, 410 W. 10th Street, Columbus, OH 43210, United States. Lanla.Conteh@osumc.edu
Telephone: +1-614-2936255 Fax: +1-614-2931456
Received: June 2, 2018
Peer-review started: June 2, 2018
First decision: July 9, 2018
Revised: July 23, 2018
Accepted: August 21, 2018
Article in press: August 21, 2018
Published online: November 27, 2018
Processing time: 178 Days and 13 Hours
Abstract
AIM

To determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma (HCC).

METHODS

A retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.

RESULTS

A total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant (OR: 2.66, 95%CI: 1.92-3.68), resection (OR: 1.82, 95%CI: 1.48-2.23), and ablation (OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant (OR: 2.18, 95%CI: 1.40-3.39) and ablation (OR: 1.46, 95%CI: 1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant (OR: 2.41, 95%CI: 1.62-3.61), resection (OR: 1.79 95%CI: 1.39-2.32), and ablation (OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between races.

CONCLUSION

Racial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.

Keywords: Racial disparity; Hepatocellular carcinoma; Liver transplantation; Resection; Ablation

Core tip: Racial disparities in the treatment of hepatocellular carcinoma (HCC) have been noted previously. This study investigated continued disparities in healthcare utilizing the Nationwide Inpatient Sample. African-American patients were less likely to undergo curative treatments, such as liver transplantation, liver resection, ablation, and transarterial chemoablation for HCC despite having less features of liver decompensation.