Treatment Disparities Partially Mediate Socioeconomic- and Race/Ethnicity-Based Survival Disparities in Stage I-II Hepatocellular Carcinoma.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
05
07
2022
accepted:
24
07
2023
medline:
12
10
2023
pubmed:
8
9
2023
entrez:
7
9
2023
Statut:
ppublish
Résumé
Low socioeconomic status (SES) patients with early-stage hepatocellular carcinoma (HCC) receive procedural treatments less often and have shorter survival. Little is known about the extent to which these survival disparities result from treatment-related disparities versus other causal pathways. We aimed to estimate the proportion of SES-based survival disparities that are mediated by treatment- and facility-related factors among patients with stage I-II HCC. We analyzed patients aged 18-75 years diagnosed with stage I-II HCC in 2008-2016 using the National Cancer Database. Inverse odds weighting mediation analysis was used to calculate the proportion mediated by three mediators: procedure type, facility volume, and facility procedural interventions offered. Intersectional analyses were performed to determine whether treatment disparities played a larger role in survival disparities among Black and Hispanic patients. Among 46,003 patients, 15.0% had low SES, 71.6% had middle SES, and 13.4% had high SES. Five-year overall survival was 46.9%, 39.9%, and 35.7% among high, middle, and low SES patients, respectively. Procedure type mediated 45.9% (95% confidence interval [CI] 31.1-60.7%) and 36.7% (95% CI 25.7-47.7%) of overall survival disparities for low and middle SES patients, respectively, which was more than was mediated by the two facility-level mediators. Procedure type mediated a larger proportion of survival disparities among low-middle SES Black (46.6-48.2%) and Hispanic patients (92.9-93.7%) than in White patients (29.5-29.7%). SES-based disparities in use of procedural interventions mediate a large proportion of survival disparities, particularly among Black and Hispanic patients. Initiatives aimed at attenuating these treatment disparities should be pursued.
Sections du résumé
BACKGROUND
BACKGROUND
Low socioeconomic status (SES) patients with early-stage hepatocellular carcinoma (HCC) receive procedural treatments less often and have shorter survival. Little is known about the extent to which these survival disparities result from treatment-related disparities versus other causal pathways. We aimed to estimate the proportion of SES-based survival disparities that are mediated by treatment- and facility-related factors among patients with stage I-II HCC.
METHODS
METHODS
We analyzed patients aged 18-75 years diagnosed with stage I-II HCC in 2008-2016 using the National Cancer Database. Inverse odds weighting mediation analysis was used to calculate the proportion mediated by three mediators: procedure type, facility volume, and facility procedural interventions offered. Intersectional analyses were performed to determine whether treatment disparities played a larger role in survival disparities among Black and Hispanic patients.
RESULTS
RESULTS
Among 46,003 patients, 15.0% had low SES, 71.6% had middle SES, and 13.4% had high SES. Five-year overall survival was 46.9%, 39.9%, and 35.7% among high, middle, and low SES patients, respectively. Procedure type mediated 45.9% (95% confidence interval [CI] 31.1-60.7%) and 36.7% (95% CI 25.7-47.7%) of overall survival disparities for low and middle SES patients, respectively, which was more than was mediated by the two facility-level mediators. Procedure type mediated a larger proportion of survival disparities among low-middle SES Black (46.6-48.2%) and Hispanic patients (92.9-93.7%) than in White patients (29.5-29.7%).
CONCLUSIONS
CONCLUSIONS
SES-based disparities in use of procedural interventions mediate a large proportion of survival disparities, particularly among Black and Hispanic patients. Initiatives aimed at attenuating these treatment disparities should be pursued.
Identifiants
pubmed: 37679537
doi: 10.1245/s10434-023-14132-9
pii: 10.1245/s10434-023-14132-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7309-7318Informations de copyright
© 2023. Society of Surgical Oncology.
Références
Hoehn RS, Hanseman DJ, Jernigan PL, et al. Disparities in care for patients with curable hepatocellular carcinoma. HPB (Oxford). 2015;17(9):747–52.
doi: 10.1111/hpb.12427
pubmed: 26278321
pmcid: 4557647
Hoehn RS, Hanseman DJ, Wima K, et al. Does race affect management and survival in hepatocellular carcinoma in the United States? Surgery. 2015;158(5):1244–51.
doi: 10.1016/j.surg.2015.03.026
pubmed: 25958069
Chidi AP, Bryce CL, Myaskovsky L, et al. Differences in physician referral drive disparities in surgical intervention for hepatocellular carcinoma: a retrospective cohort study. Ann Surg. 2016;263(2):362–8.
doi: 10.1097/SLA.0000000000001111
pubmed: 25563883
Hoehn RS, Hanseman DJ, Dhar VK, et al. Opportunities to improve care of hepatocellular carcinoma in vulnerable patient populations. J Am Coll Surg. 2017;224(4):697–704.
doi: 10.1016/j.jamcollsurg.2016.12.023
pubmed: 28069526
Peters NA, Javed AA, He J, et al. Association of socioeconomics, surgical therapy, and survival of early stage hepatocellular carcinoma. J Surg Res. 2017;210:253–60.
doi: 10.1016/j.jss.2016.11.042
pubmed: 28457336
Cotton RT, Tran Cao HS, Rana AA, et al. Impact of the treating hospital on care outcomes for hepatocellular carcinoma. Hepatology. 2018;68(5):1879–89.
doi: 10.1002/hep.30128
pubmed: 30070392
Abdel-Rahman O. Treatment choices and outcomes of non-metastatic hepatocellular carcinoma patients in relationship to neighborhood socioeconomic status: a population-based study. Int J Clin Oncol. 2020;25(5):861–6.
doi: 10.1007/s10147-020-01616-x
pubmed: 31953780
Flores YN, Datta GD, Yang L, et al. Disparities in hepatocellular carcinoma incidence, stage, and survival: a large population-based study. Cancer Epidemiol Biomark Prev. 2021;30(6):1193–9.
doi: 10.1158/1055-9965.EPI-20-1088
Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.
doi: 10.3322/caac.21654
pubmed: 33433946
Swords DS, Mulvihill SJ, Brooke BS, et al. Size and importance of socioeconomic status-based disparities in use of surgery in nonadvanced stage gastrointestinal cancers. Ann Surg Oncol. 2020;27(2):333–41.
doi: 10.1245/s10434-019-07922-7
pubmed: 31605347
Swords DS, Scaife CL. Decompositions of the contribution of treatment disparities to survival disparities in stage I-II pancreatic adenocarcinoma. Ann Surg Oncol. 2021;28(6):3157–68.
doi: 10.1245/s10434-020-09267-y
pubmed: 33145705
Jackson JW, Williams DR, VanderWeele TJ. Disparities at the intersection of marginalized groups. Soc Psychiatry Psychiatr Epidemiol. 2016;51(10):1349–59.
doi: 10.1007/s00127-016-1276-6
pubmed: 27531592
pmcid: 5350011
Jackson JW, VanderWeele TJ. Intersectional decomposition analysis with differential exposure, effects, and construct. Soc Sci Med. 2019;226:254–9.
doi: 10.1016/j.socscimed.2019.01.033
pubmed: 30770131
pmcid: 6886261
Chen JC, Obeng-Gyasi S. Intersectionality and the surgical patient: expanding the surgical disparities framework. Ann Surg. 2022;275(1):e3–5.
doi: 10.1097/SLA.0000000000005045
pubmed: 34225298
Swords DS, Mulvihill SJ, Brooke BS, et al. Disparities in utilization of treatment for clinical stage I-II pancreatic adenocarcinoma by area socioeconomic status and race/ethnicity. Surgery. 2019;165(4):751–9.
doi: 10.1016/j.surg.2018.10.035
pubmed: 30551868
Nathan H, Bridges JF, Schulick RD, et al. Understanding surgical decision making in early hepatocellular carcinoma. J Clin Oncol. 2011;29(6):619–25.
doi: 10.1200/JCO.2010.30.8650
pubmed: 21205759
pmcid: 4834708
Nathan H, Segev DL, Bridges JF, et al. Influence of nonclinical factors on choice of therapy for early hepatocellular carcinoma. Ann Surg Oncol. 2013;20(2):448–56.
doi: 10.1245/s10434-012-2619-5
pubmed: 22941170
Tchetgen Tchetgen EJ. Inverse odds ratio-weighted estimation for causal mediation analysis. Stat Med. 2013;32(26):4567–80.
doi: 10.1002/sim.5864
pubmed: 23744517
pmcid: 3954805
Nguyen QC, Osypuk TL, Schmidt NM, et al. Practical guidance for conducting mediation analysis with multiple mediators using inverse odds ratio weighting. Am J Epidemiol. 2015;181(5):349–56.
doi: 10.1093/aje/kwu278
pubmed: 25693776
pmcid: 4339385
Mallin K, Browner A, Palis B, et al. Incident cases captured in the national cancer database compared with those in U.S. population based central cancer registries in 2012–2014. Ann Surg Oncol. 2019;26(6):1604–12.
doi: 10.1245/s10434-019-07213-1
pubmed: 30737668
Giobbie-Hurder A, Gelber RD, Regan MM. Challenges of guarantee-time bias. J Clin Oncol. 2013;31(23):2963–9.
doi: 10.1200/JCO.2013.49.5283
pubmed: 23835712
pmcid: 3732313
Miller BJ, Gao Y, Duchman KR. Socioeconomic measures influence survival in osteosarcoma: an analysis of the National Cancer Data Base. Cancer Epidemiol. 2017;49:112–7.
doi: 10.1016/j.canep.2017.05.017
pubmed: 28601784
Sauer BC, Brookhart A, Roy J, et al. A review of covariate selection for non-experimental comparative effectiveness research. Pharmacoepidemiol Drug Saf. 2013;22(11):1139–45.
doi: 10.1002/pds.3506
pubmed: 24006330
pmcid: 4190055
VanderWeele TJ. Principles of confounder selection. Eur J Epidemiol. 2019;34(3):211–9.
doi: 10.1007/s10654-019-00494-6
pubmed: 30840181
pmcid: 6447501
Bailey ZD, Krieger N, Agénor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63.
doi: 10.1016/S0140-6736(17)30569-X
pubmed: 28402827
Birkmeyer JD, Sun Y, Wong SL, et al. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777–83.
doi: 10.1097/01.sla.0000252402.33814.dd
pubmed: 17457171
pmcid: 1877074
Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Legal Forum. 1989;1:139–67.
Crenshaw K. Mapping the margins: Intersectionality, identity, politics, and violence against women of color. Stanf Law Rev. 1991;43(6):1241–99.
doi: 10.2307/1229039
Jackson JW. Explaining intersectionality through description, counterfactual thinking, and mediation analysis. Soc Psychiatry Psychiatr Epidemiol. 2017;52(7):785–93.
doi: 10.1007/s00127-017-1390-0
pubmed: 28540515
Valeri L, VanderWeele TJ. SAS macro for causal mediation analysis with survival data. Epidemiology. 2015;26(2):e23-24.
doi: 10.1097/EDE.0000000000000253
pubmed: 25643116
Wang Z, Gu X, Thrift AP. Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: a sequential matching cohort study. PLoS ONE. 2019;14(4):e0214721.
doi: 10.1371/journal.pone.0214721
pubmed: 30943273
pmcid: 6447218
Unger J, Moseley A, Cheung C, et al. Persistent disparity: socioeconomic deprivation and cancer outcomes in patients treated in clinical trials. J Clin Oncol. 2021;39(12):1339–48.
doi: 10.1200/JCO.20.02602
pubmed: 33729825
pmcid: 8078474
Bryce CL, Angus DC, Arnold RM, et al. Sociodemographic differences in early access to liver transplantation services. Am J Transplant. 2009;9(9):2092–101.
doi: 10.1111/j.1600-6143.2009.02737.x
pubmed: 19645706
pmcid: 2880404
Mathur AK, Ashby VB, Fuller DS, et al. Variation in access to the liver transplant waiting list in the United States. Transplantation. 2014;98(1):94–9.
doi: 10.1097/01.TP.0000443223.89831.85
pubmed: 24646768
pmcid: 4211283
Nephew LD, Serper M. Racial, gender, and socioeconomic disparities in liver transplantation. Liver Transpl. 2021;27(6):900–12.
doi: 10.1002/lt.25996
pubmed: 33492795
Rosenblatt R, Wahid N, Halazun KJ, et al. Black patients have unequal access to listing for liver transplantation in the United States. Hepatology. 2021;74(3):1523–32.
doi: 10.1002/hep.31837
pubmed: 33779992
Warren C, Carpenter AM, Neal D, et al. Racial disparity in liver transplantation listing. J Am Coll Surg. 2021;232(4):526–34.
doi: 10.1016/j.jamcollsurg.2020.12.021
pubmed: 33444709
pmcid: 8143858
Dakhoul L, Gawrieh S, Jones KR, et al. Racial disparities in liver transplantation for hepatocellular carcinoma are not explained by differences in comorbidities, liver disease severity, or tumor burden. Hepatol Commun. 2019;3(1):52–62.
doi: 10.1002/hep4.1277
pubmed: 30619994
Brown CS, Waits SA, Englesbe MJ, et al. Associations among different domains of quality among US liver transplant programs. JAMA Netw Open. 2021;4(8):e2118502.
doi: 10.1001/jamanetworkopen.2021.18502
pubmed: 34369991
pmcid: 8353538
Kaplan A, Wahid N, Fortune BE, Verna E, Halazun K, Samstein B, Brown RS Jr, Rosenblatt R. Black patients and women have reduced access to liver transplantation for alcohol-associated liver disease. Liver Transpl. 2023;29(3):259–67.
doi: 10.1002/lt.26544
pubmed: 35848134