title: Predictors of surgical intervention for hepatocellular carcinoma: race, socioeconomic status, and hospital type.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  California Cancer Registry data linked to the Office of Statewide Health Planning and Development patient discharge abstracts between 1996 and 2006.
  
  
  METHODS
  Patients with primary HCC.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  There are significant racial, socioeconomic, and hospital-type disparities in surgical treatment of HCC.
authors.affiliation: Department of Surgery, Stanford University Medical Center, Stanford, CA 94305-5641, USA.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Zak
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006761:Hospitals / Q000145:classification*; D006801:Humans; D008113:Liver Neoplasms / Q000208:ethnology / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors