title: Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma.
abstract: OBJECTIVE
  To determine whether controlling for differences in the use of invasive therapy affects racial/ethnic differences in survival of early-stage hepatocellular carcinoma (HCC).
  
  
  METHODS
  A retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) HCC data. Invasive therapy was defined as tumor ablation, hepatectomy, or liver transplant. Race/ethnicity was defined as white, black, Asian, Hispanic, or other. Racial/ethnic differences in overall and treatment-adjusted survival were assessed using the Kaplan-Meier method and base- and treatment-stratified multivariable Cox proportional hazards models.
  
  
  METHODS
  All patients diagnosed as having stage I or II HCC from January 1, 1995, through December 31, 2006 (N = 13 244).
  
  
  METHODS
  Data were obtained from the National Cancer Institute's SEER registry.
  
  
  METHODS
  Differences in survival by race/ethnicity accounting for the use of invasive therapy and treatment benefit.
  
  
  RESULTS
  Overall, 32.8% of patients received invasive therapy. We found higher mortality rates in the base survival model for black (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15-1.33) and Hispanic (1.08; 1.01-1.15) patients and lower mortality rates in Asian patients (0.87; 0.82-0.93) compared with whites. After treatment stratification, compared with white patients, blacks had a 12% higher mortality rate (HR, 1.11; 95% CI, 1.03-1.20), Hispanics had a similar mortality rate (0.97; 0.91-1.04), and Asians had a 16% lower mortality rate (0.84; 0.79-0.89).
  
  
  CONCLUSIONS
  For early-stage HCC, racial/ethnic disparities in survival between minority and white patients are notable. After accounting for differences in stage, use of invasive therapy, and treatment benefit, no racial/ethnic survival disparity is evident between Hispanics and whites, but blacks have persistently poor survival.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, 48109, USA.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Osborne
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Lynch
authors.forename: Amir A
authors.initials: AA
authors.lastname: Ghaferi
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
mesh_terms: D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States