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Geographic hotspot detection for late-stage hepatocellular carcinoma: novel approach to cancer control

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Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Importance

As hepatocellular carcinoma (HCC)-associated mortality continues to rise in the United States, there is a crucial need for strategies to shift diagnoses from late to early stage in order to improve survival.

Objective

To describe a population-based geospatial approach to identifying areas with high late-stage HCC burden for intervention.

Design

Cross-sectional study between 2008 and 2017.

Setting

Los Angeles County.

Participants

All incident cases of HCC with residential address at diagnosis in Los Angeles County were identified from a population-based cancer registry. Late stage included AJCC 7th Edition stages III–IV and unstaged cases.

Exposure

Sociodemographic factors.

Main outcome(s)

Geographic “hotspots” or areas with a high density of late-stage HCC, identified using kernel density estimation in ArcMap 10.3.1.

Results

51.8% of 7,519 incident cases of HCC were late stage. We identified a total of 23 late-stage hotspots, including 30.0% of all late-stage cases. Cases within hotspots were more often racial/ethnic minorities, foreign-born, under or uninsured, and of lower socioeconomic status. The age-adjusted incidence rate of late-stage HCC was twofold higher within hotspots (6.85 per 100,000 in hotspots vs 3.38 per 100,000 outside of hotspots). The calculated population-attributable risk was 43%, suggesting that a substantial proportion of late-stage HCC burden could be averted by introducing interventions in hotspot areas. We mapped the relationship between hotspots and federally qualified health centers primary care clinics and subspecialty clinics in Los Angeles County to demonstrate how clinic partnerships can be selected to maximize impact of interventions and resource use. Hotspots can also be utilized to identify “high-risk” neighborhoods that are easily recognizable by patients and the public and to facilitate community partnerships.

Conclusion and relevance

Reducing late-stage HCC through geographic late-stage hotspots may be an efficient approach to improving cancer control and equity.

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Data availability

The data that support the findings of this study are available from the Los Angeles County Cancer Surveillance Registry. The data are not publicly available due to restrictions from the registry as they contain information that could compromise confidentiality of cancer patients.

Abbreviations

AAIR:

Age-adjusted incidence rate

AJCC:

American Joint Committee on Cancer

API:

Asian Pacific Islander

FQHC:

Federally Qualified Health Center

GI/HEP:

Gastroenterology and hepatology

HCC:

Hepatocellular carcinoma

LAC:

Los Angeles County

LACSP:

Los Angeles Cancer Surveillance Program

PAR:

Population-attributable risk

SES:

Socioeconomic status

US:

United States

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Funding

This work was supported by a University of Southern California Research Center for Liver Diseases grant 5P30DK048522 to Dr. Zhou. This work was also supported in part by the Population Research Core of the USC/Norris Comprehensive Cancer Center funded by the National Cancer Institute grant P30CA014089. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Kali Zhou & Norah A. Terrault

  2. USC Research Center for Liver Disease, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Kali Zhou & Norah A. Terrault

  3. Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA

    Laura K. Thompson, Lihua Liu & Myles G. Cockburn

  4. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Lihua Liu & Myles G. Cockburn

Authors
  1. Kali Zhou
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  2. Laura K. Thompson
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  3. Lihua Liu
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  4. Norah A. Terrault
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  5. Myles G. Cockburn
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Contributions

KZ is the guarantor of the article and all authors approved the final version of the manuscript. The authors made the following contributions: Concept and design: KZ, LT, and MC. Acquisition, analysis, or interpretation of data: KZ, LT, and MC. Statistical analysis: LT and MC. Drafting of the manuscript: KZ. Critical revision of the manuscript for important intellectual content: All authors.

Corresponding author

Correspondence to Kali Zhou.

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Conflict of interest

Dr. Zhou and Dr. Terrault report institutional grant support from Gilead Sciences. The other authors report no disclosures.

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Zhou, K., Thompson, L.K., Liu, L. et al. Geographic hotspot detection for late-stage hepatocellular carcinoma: novel approach to cancer control. Cancer Causes Control 33, 701–710 (2022). https://doi.org/10.1007/s10552-022-01555-0

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  • DOI: https://doi.org/10.1007/s10552-022-01555-0

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