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Impact of Social Determinants of Health on Outcomes Following Resection for Hepatocellular Carcinoma

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to determine the impact of social determinants of health (SDoH) on outcomes of patients undergoing resection for hepatocellular carcinoma (HCC).

Patients and Methods

Patients with HCC in the National Cancer Database who underwent resection from 2009 to 2018 were identified. SDoH associated with length of stay (LOS), 30-day readmission, and 30-day mortality were analyzed using regression analyses adjusted for confounding variables.

Results

Among 9235 patients, the median age (range) was 65.0 (18–90) years, 72.1% were male, and 57.9% were White. A total of 3% were uninsured, 11.1% had Medicaid, 21% resided in regions with a median household income within the lowest quartile of the US population, and 27.0% resided in regions within the lowest quartile of education level. The odds for having longer LOS were lower among patients with the highest regional education level compared with those with the lowest level [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.77–0.97]. The risk of readmission was lower among patients with Medicare (OR 0.52; 95% CI 0.33–0.81), Medicaid (OR 0.52; 95% CI 0.31–0.87), or private insurance (OR 0.56; 95% CI 0.35–0.88) compared with uninsured patients. Thirty-day overall mortality was less likely among patients with Medicare (OR 0.45; 95% CI 0.27–0.75), Medicaid (OR 0.53; 95% CI 0.30–0.93), or private insurance (OR 0.40; 95% CI 0.24–0.66), and among patients with high regional income (OR 0.58; 95% CI 0.44–0.77).

Conclusions

Adjusted regression analyses identified SDoH that were associated with HCC outcomes. Increased awareness of how SDoH relate to outcomes may inform strategies that attempt to account for these associations and improve patient outcomes.

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Authors and Affiliations

  1. Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA

    Ambria S. Moten MD, MS, Paxton V. Dickson MD, Jeremiah L. Deneve MD, David Shibata MD & Evan S. Glazer MD, PhD, FACS, FSSO

  2. Center for Cancer Research, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA

    David Shibata MD & Evan S. Glazer MD, PhD, FACS, FSSO

  3. Department of Acute and Tertiary Care, College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, USA

    Ansley G. Stanfill PhD, RN, FAAN

Authors
  1. Ambria S. Moten MD, MS
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  2. Paxton V. Dickson MD
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  3. Jeremiah L. Deneve MD
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  6. Evan S. Glazer MD, PhD, FACS, FSSO
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Correspondence to Evan S. Glazer MD, PhD, FACS, FSSO.

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Moten, A.S., Dickson, P.V., Deneve, J.L. et al. Impact of Social Determinants of Health on Outcomes Following Resection for Hepatocellular Carcinoma. Ann Surg Oncol 30, 738–747 (2023). https://doi.org/10.1245/s10434-022-12735-2

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