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Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Study

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

While hepatocellular carcinoma (HCC) is ideally diagnosed outpatient by screening at-risk patients, many are diagnosed in Emergency Departments (ED) due to undiagnosed liver disease and/or limited access-to-healthcare. This study aims to identify sociodemographic/clinical factors associated with being diagnosed with HCC in the ED to identify patients who may benefit from improved access-to-care.

Methods

HCC patients diagnosed between 2012 and 2014 in the ED or an outpatient setting [Primary Care Physician (PCP) or hepatologist] were identified from the US Safety-Net Collaborative database and underwent retrospective chart-review. Multivariable regression identified predictors for an ED diagnosis.

Results

Among 1620 patients, median age was 60, 68% were diagnosed outpatient, and 32% were diagnosed in the ED. ED patients were more likely male, Black/Hispanic, uninsured, and presented with more decompensated liver disease, aggressive features, and advanced clinical stage. On multivariable regression, controlling for age, gender, race/ethnicity, poverty, insurance, and PCP/navigator access, predictors for ED diagnosis were male (odds ratio [OR] 1.6, 95% confidence interval [CI]: 1.1–2.2, p = 0.010), black (OR 1.7, 95% CI: 1.2–2.3, p = 0.002), Hispanic (OR 1.6, 95% CI: 1.1–2.6, p = 0.029), > 25% below poverty line (OR 1.4, 95% CI: 1.1–1.9, p = 0.019), uninsured (OR 3.9, 95% CI: 2.4–6.1, p < 0.001), and lack of PCP (OR 2.3, 95% CI: 1.5–3.6, p < 0.001) or navigator (OR 1.8, 95% CI: 1.3–2.5, p = 0.001).

Conclusions

The sociodemographic/clinical profile of patients diagnosed with HCC in EDs differs significantly from those diagnosed outpatient. ED patients were more likely racial/ethnic minorities, uninsured, and had limited access to healthcare. This study highlights the importance of improved access-to-care in already vulnerable populations.

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Acknowledgment

This research was supported by the National Institute of Health under a training Grant, T32CA211034.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Joshua P. Kronenfeld MD, Emily L. Ryon MD MPH, Alan S. Livingstone MD, Nipun B. Merchant MD & Neha Goel MD

  2. Division of Digestive Health and Liver Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA

    David Goldberg MD MSCE

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Rachel M. Lee MD MSPH & Maria C. Russell MD

  4. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA

    Adam Yopp MD

  5. Division of Surgical Oncology, Department of Surgery, NYU Langone Health, New York, NY, USA

    Annie Wang MD & Ann Y. Lee MD

  6. Division of Surgical Oncology, Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Sommer Luu BS, Cary Hsu MD & Eric Silberfein MD

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  1. Joshua P. Kronenfeld MD
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  2. Emily L. Ryon MD MPH
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Correspondence to Neha Goel MD.

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Kronenfeld, J.P., Ryon, E.L., Goldberg, D. et al. Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Study. Ann Surg Oncol 28, 1929–1936 (2021). https://doi.org/10.1245/s10434-020-09156-4

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  • DOI: https://doi.org/10.1245/s10434-020-09156-4

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