V72: Association of County-level Upward Economic Mobility with Receipt of Surgical Treatment Among Patients Diagnosed with Hepatocellular Carcinoma

Monday, February 28, 2022

6:07 PM – 6:10 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Timothy M. Pawlik, MD, PhD

Chair of Surgery
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure: Disclosure information not submitted.

Participants should be aware of the following financial/non-financial relationships:

Timothy M. Pawlik, MD, PhD: Disclosure information not submitted.

Introduction: Upward economic mobility is the ability of children to surpass their parents financially and improve their family economic status. The extent to which upward economic mobility contributes to socioeconomic disparities in cancer diagnosis and treatment remains largely unknown.

Methods:

Patients diagnosed with hepatocellular carcinoma (HCC) between 2004 and 2015 were identified from the SEER-Medicare linked database. Information on county-level upward economic mobility was obtained from the Opportunity Atlas. The impact of economic mobility on early-stage diagnosis (stage I or II) and receipt of surgical treatment was analyzed and stratified by race/ethnicity.

Results:

Among 10,987 patients diagnosed with HCC, median age was 73 (IQR, 68-79) and a majority was male (n=7,502, 68.3%). Almost two thirds of patients were White (n=7,233, 65.8%), while other patients were either Black (n=1,059, 9.6%) or did not identify as either White or Black (n=2,695, 24.5%). Although most patients were diagnosed with stage I (n=4,467, 40.7%) or stage II disease (n=1,843, 16.8%), only a small minority of patients underwent surgical resection (n=930, 8.5%). On multivariable analysis, residing in a high versus low economic mobility county was not associated with stage at diagnosis (OR 1.10, 95%CI 0.99-1.23; p=0.09); however, patients who lived in high upward mobility communities had 89% (OR 1.89, 95%CI 1.54-2.33; p< 0.001) increased odds to undergo surgical resection of HCC. Additional analyses stratifing patients by race/ethnicity demonstrated that patients residing in high upward economic mobility areas remained much more likely to receive surgery than patients from low upward economic mobility areas independent of race/ethnicity (White: OR 1.15, 95%CI 1.24-2.04; Black: OR 3.16, 95%CI 1.28-7.79; Other: 2.89, 95%CI 1.85-4.50).

Conclusions:

Despite similar HCC disease stage at diagnosis, patients residing in areas with higher upward economic mobility were markedly more likely to undergo surgical resection of HCC. The impact of county-level upward economic mobility on receipt of surgical treatment was independent of patient race/ethnicity.

Learning Objectives:

define what upward economic mobility is and its potential contribution to health disparities.
describe the association of county-level upward economic mobility with early-stage diagnosis and receipt of surgical resection among HCC patients.
assess the impact of county-level upward economic mobility on early-stage diagnosis and receipt of surgical resection among patients of different races/ethnicities.