title: Persistent disparities in liver transplantation for patients with hepatocellular carcinoma in the United States, 1998 through 2007.
abstract: BACKGROUND
  Prior studies have demonstrated that among patients with hepatocellular carcinoma (HCC), African Americans (AAs) and Asian/Pacific Islanders (APIs) are substantially less likely to undergo liver transplantation (LT) compared with whites. The authors examined whether disparities in the receipt of LT among LT-eligible HCC patients changed over a 10-year time period, and whether the disparities might be explained by sociodemographic or clinical factors.
  
  
  METHODS
  The National Cancer Data Base, a national hospital-based cancer registry, was used to study 7707 adults with small (≤ 5 cm), nonmetastatic HCC diagnosed between 1998 and 2007. Racial/ethnic patterns in the use of LT were compared during 2 periods of 5 years each: 1998 through 2002 (n = 2412 patients) and 2003 through 2007 (n = 5295 patients). Data regarding comorbid medical conditions were only available during the later time period.
  
  
  RESULTS
  Large and persistent racial/ethnic differences in the probability of receiving LT were observed. Compared with whites, hazard ratios (HRs) and associated 95% confidence intervals (95% CIs) for receiving LT from 1998 through 2002 were 0.64 (95% CI, 0.46-0.89) for AA patients, 1.01 (95% CI, 0.79-1.29) for Hispanic patients, and 0.52 (95% CI, 0.39-0.68) for API patients. Analogous results for 2003 through 2007 were 0.64 (95% CI, 0.54-0.76) for AA patients, 0.86 (95% CI, 0.75-0.99) for Hispanic patients, and 0.58 (95% CI, 0.49-0.69) for API patients. AA patients were less likely than whites to undergo any form of surgery, and API patients were more likely than whites to undergo surgical resection. Adjustment for sociodemographic and clinical factors produced only small changes in these HRs.
  
  
  CONCLUSIONS
  Between 1998 and 2007, there were large and persistent racial/ethnic disparities noted in the receipt of LT among patients with HCC. These disparities were not explained by sociodemographic or clinical factors.
authors: Department of Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia, USA. anthony.robbins@cancer.org
authors: Anthony S
authors: AS
authors: Robbins
authors: Derrick D
authors: DD
authors: Cox
authors: Lynt B
authors: LB
authors: Johnson
authors: Elizabeth M
authors: EM
authors: Ward
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D044466:Asian People; D006528:Carcinoma, Hepatocellular / Q000208:ethnology* / Q000628:therapy; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008113:Liver Neoplasms / Q000208:ethnology* / Q000628:therapy; D016031:Liver Transplantation / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States; D044465:White People