D0520 - Socioeconomic Status and the Risk of Liver Cancer Mortality in the United States: A Surveillance, Epidemiology, and End Results (SEER) Database Population-Based Study 2010-2018

Faris Hammad, MD¹, Abdul Rahman Al Armashi, MD², Dina Elantably, MD³, Anas Al Zubaidi, MD⁴, Mohamed Homeida, MD¹, Apoorva Krishna Chandar, MD², Akram Alkrekshi, MD^3
1St. Vincent Charity Medical Center, Cleveland, OH; ²University Hospitals Case Western Reserve University, Cleveland, OH; ³MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH; ⁴Johns Hopkins University, Baltimore, MD

Introduction: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and it is tied with gastric cancer as the third leading cause of cancer mortality. Survival in HCC has been established in literature, it varies by the etiology, stage of cancer at diagnosis, patient comorbidities and treatment. However, the impact of socioeconomic status (SES) on HCC survival is less clearly identified.

Methods: The relationship between socioeconomic status (SES) variables and HCC mortality was examined using the Surveillance, Epidemiology, and End Results (SEER) Program 18 registry. We included HCC cases diagnosed between 2010 through 2018. The following SES data were gathered: race, insurance status, and marital status. Covariate survival analyses were conducted using a multivariable Cox proportional hazard model to estimate hazard ratios (HR), 95% confidence interval (CI), and survival curves for SES variables. All analyses were conducted using SPSS software, version 28.0 (IBM).

Results: We have included 45,524 patients diagnosed with HCC between 2010 and 2018. Compared to insured individuals, uninsured and patients receiving Medicaid were at 94% and 29% higher risk of mortality (HR 1.949, 95% CI 1.845-2.059, HR 1.291, 95% CI 1.256-1.328, respectively). The mortality was also significantly higher by 7% in single (never married) and 9% in widowed (HR 1.078, 95% CI 1.037-1.121, and 1.097, 95% CI 1.047-1.150, respectively), while statistically lower by 10.1% in married individuals compared to divorced. Compared to females, males were at higher risk of mortality by 15% (HR 1.152, 95% CI 1.122-1.183). Finally, as regards to racial differences, risk of death was statistically lower in white and other races compared to black by 8.6% and 26% (HR 0.94, 95% CI 0.884-0.945 and HR 0.737 95% CI 0.706-0.769, respectively).

Discussion: This study demonstrates the impact of SES variables on HCC mortality, suggesting that SES is an independent predictor of liver cancer mortality. Married and insured had the most favorable survival outcome, while uninsured and single had the lowest. Moreover, white population is at lower mortality risk compared to black. Preventive interventions need to be more focused on the disadvantaged groups in order to reduce health disparities related to liver cancer mortality.



Disclosures:


Faris Hammad, MD¹, Abdul Rahman Al Armashi, MD², Dina Elantably, MD³, Anas Al Zubaidi, MD⁴, Mohamed Homeida, MD¹, Apoorva Krishna Chandar, MD², Akram Alkrekshi, MD³. D0520 - Socioeconomic Status and the Risk of Liver Cancer Mortality in the United States: A Surveillance, Epidemiology, and End Results (SEER) Database Population-Based Study 2010-2018, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.