TY - JOUR
T1 - Predictors of surgical intervention for hepatocellular carcinoma
T2 - Race, socioeconomic status, and hospital type
AU - Zak, Yulia
AU - Rhoads, Kim F.
AU - Visser, Brendan C.
PY - 2011/7
Y1 - 2011/7
N2 - Objectives: To define current use of surgical therapies for hepatocellular carcinoma (HCC) and evaluate the correlation of various patient and hospital characteristics with the receipt of these interventions. Design: Retrospective cohort. Setting: California Cancer Registry data linked to the Office of Statewide Health Planning and Development patient discharge abstracts between 1996 and 2006. Patients: Patients with primary HCC. Main Outcome Measures: Receipt of liver transplant, hepatic resection, or local ablation. Results: Of 12 148 HCC cases, 2390 (20%) underwent surgical intervention. Three hundred eleven (2.56%) received a liver transplant, 1307 (10.8%) underwent resection, and 772 (6.35%) had local ablation. There were wide variations in treatment by race and hospital type. African American and Hispanic patients were less likely than white patients to undergo transplant (P < .05). African American and Hispanic patients were less likely than white and Asian/Pacific Islander patients to have hepatectomy or ablation (P < .05). In multivariable analysis, the apparent differences in surgical intervention by race/ethnicity were decreased when adjusting for the patients' socioeconomic and insurance statuses. Patients with lower socioeconomic status and no private insurance were less likely to receive any surgery (P < .01). Hospital characteristics also explained some variations. Disproportionate Share Hospitals and public, rural, and nonteaching hospitals were less likely to offer surgical treatment (P < .01). Conclusion: There are significant racial, socioeconomic, and hospital-type disparities in surgical treatment of HCC.
AB - Objectives: To define current use of surgical therapies for hepatocellular carcinoma (HCC) and evaluate the correlation of various patient and hospital characteristics with the receipt of these interventions. Design: Retrospective cohort. Setting: California Cancer Registry data linked to the Office of Statewide Health Planning and Development patient discharge abstracts between 1996 and 2006. Patients: Patients with primary HCC. Main Outcome Measures: Receipt of liver transplant, hepatic resection, or local ablation. Results: Of 12 148 HCC cases, 2390 (20%) underwent surgical intervention. Three hundred eleven (2.56%) received a liver transplant, 1307 (10.8%) underwent resection, and 772 (6.35%) had local ablation. There were wide variations in treatment by race and hospital type. African American and Hispanic patients were less likely than white patients to undergo transplant (P < .05). African American and Hispanic patients were less likely than white and Asian/Pacific Islander patients to have hepatectomy or ablation (P < .05). In multivariable analysis, the apparent differences in surgical intervention by race/ethnicity were decreased when adjusting for the patients' socioeconomic and insurance statuses. Patients with lower socioeconomic status and no private insurance were less likely to receive any surgery (P < .01). Hospital characteristics also explained some variations. Disproportionate Share Hospitals and public, rural, and nonteaching hospitals were less likely to offer surgical treatment (P < .01). Conclusion: There are significant racial, socioeconomic, and hospital-type disparities in surgical treatment of HCC.
UR - http://www.scopus.com/inward/record.url?scp=79960386270&partnerID=8YFLogxK
U2 - 10.1001/archsurg.2011.37
DO - 10.1001/archsurg.2011.37
M3 - Article
C2 - 21422327
AN - SCOPUS:79960386270
SN - 0004-0010
VL - 146
SP - 778
EP - 784
JO - Archives of Surgery
JF - Archives of Surgery
IS - 7
ER -