title: Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival.
  
  
  METHODS
  To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry.
  
  
  RESULTS
  Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95% confidence interval (95% CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95% CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95% CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95% CI, 1.03-1.48).
  
  
  CONCLUSIONS
  Our hypothesis that survival outcomes would differ by ethnicity was verified.
  
  
  CONCLUSIONS
  Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.
authors.affiliation: Cancer Surveillance Research Unit, Cancer Surveillance and Research Branch, California Department of Public Health, San Francisco, CA, USA.
authors.forename: Sandy L
authors.initials: SL
authors.lastname: Kwong
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stewart
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Aoki
authors.forename: Moon S
authors.initials: MS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000208:ethnology; D002140:California / Q000453:epidemiology / Q000208:ethnology; D006528:Carcinoma, Hepatocellular / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D018426:SEER Program
references.citation: J Gen Intern Med. 2010 Jul;25(7):694-700
references.pmid: 20306150
references.citation: MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20
references.pmid: 18802412
references.citation: Am J Surg. 2008 Jun;195(6):829-36
references.pmid: 18436176
references.citation: Semin Liver Dis. 1999;19(3):329-38
references.pmid: 10518312
references.citation: Am J Epidemiol. 2007 Jul 1;166(1):97-103
references.pmid: 17463050
references.citation: Ethn Dis. 1998;8(2):218-27
references.pmid: 9681287
references.citation: Cancer. 2005 Dec 15;104(12 Suppl):2895-902
references.pmid: 16270313
references.citation: Hepatol Res. 2007 Sep;37 Suppl 2:S88-94
references.pmid: 17877502
references.citation: Cancer Causes Control. 2006 Apr;17(3):267-72
references.pmid: 16489534
references.citation: Cancer. 2008 Oct 15;113(8):2173-9
references.pmid: 18792066
references.citation: Oral Oncol. 2005 Jul;41(6):596-601
references.pmid: 15975522
references.citation: Cancer Causes Control. 1998 Aug;9(4):369-80
references.pmid: 9794168
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Oct;18(10):2701-8
references.pmid: 19789367
references.citation: J Clin Gastroenterol. 2007 Sep;41(8):777-82
references.pmid: 17700427
references.citation: J Epidemiol Community Health. 2009 Oct;63(10):856-61
references.pmid: 19542076
references.citation: Cancer Causes Control. 1997 Sep;8(5):705-12
references.pmid: 9328192
references.citation: World J Surg. 2007 Jun;31(6):1243-8
references.pmid: 17440771
references.citation: Cancer. 2010 Feb 1;116(3):544-73
references.pmid: 19998273
references.citation: Clin Gastroenterol Hepatol. 2006 Jan;4(1):104-10; quiz 4-5
references.pmid: 16431312
references.citation: Clin Liver Dis. 2009 Feb;13(1):63-66
references.pmid: 19150310
references.citation: Cancer Causes Control. 2004 Apr;15(3):243-53
references.pmid: 15090719
references.citation: Hepatology. 2005 Apr;41(4):707-16
references.pmid: 15795889
references.citation: J Health Care Poor Underserved. 2010 Aug;21(3):839-50
references.pmid: 20693730
references.citation: Rev Gastroenterol Disord. 2003 Summer;3(3):125-34
references.pmid: 14502116
references.citation: Am J Gastroenterol. 2008 Jan;103(1):120-7
references.pmid: 18005365
references.citation: Hepatology. 2007 Feb;45(2):507-39
references.pmid: 17256718
references.citation: Cancer. 2010 Mar 1;116(5):1367-77
references.pmid: 20101732
references.citation: Oncology. 2002;62 Suppl 1:8-17
references.pmid: 11868791
references.citation: Cancer Causes Control. 2006 Aug;17(6):771-81
references.pmid: 16783605
references.citation: J Cancer Educ. 2007 Winter;22(4):266-72
references.pmid: 18067441
references.citation: Am J Prev Med. 2004 Aug;27(2):132-8
references.pmid: 15261900
references.citation: J Clin Gastroenterol. 2010 Mar;44(3):e63-70
references.pmid: 19745756
references.citation: BMC Cancer. 2009 Feb 04;9:46
references.pmid: 19193234
references.citation: Am J Epidemiol. 2007 Nov 1;166(9):1105-6; author reply 1106-7
references.pmid: 17881381
references.citation: Hepatology. 2007 Oct;46(4):1034-40
references.pmid: 17654490
references.citation: CA Cancer J Clin. 2007 Jul-Aug;57(4):190-205
references.pmid: 17626117
references.citation: Gut. 2005 Mar;54(3):411-8
references.pmid: 15710992
references.citation: Cancer Causes Control. 2008 Apr;19(3):227-56
references.pmid: 18066673
references.citation: Prev Med. 2010 Jan-Feb;50(1-2):63-7
references.pmid: 19716379
references.citation: J Gastroenterol Hepatol. 2009 Mar;24(3):346-53
references.pmid: 19220670
references.citation: Cancer. 2005 Dec 15;104(12 Suppl):2975-81
references.pmid: 16247792
references.citation: Cancer. 2005 Dec 15;104(12 Suppl):2969-74
references.pmid: 16247793
references.citation: Prev Med. 2010 Jan-Feb;50(1-2):68-73
references.pmid: 19883680
references.citation: Cancer Causes Control. 2001 Oct;12(8):703-11
references.pmid: 11562110
references.citation: Cancer. 2007 May 15;109(10):2100-8
references.pmid: 17385214
references.citation: Br J Cancer. 2004 Oct 4;91(7):1229-35
references.pmid: 15305188