title: Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States.
abstract: BACKGROUND
  Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice.
  
  
  OBJECTIVE
  To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics.
  
  
  METHODS
  We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation.
  
  
  RESULTS
  We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2-53.4%) and 21.8% (95% CI 21.4-22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1-59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts.
  
  
  CONCLUSIONS
  Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.
authors: School of Public Health, UNT Health Science Center, Fort Worth, TX, USA.
authors: D
authors: D
authors: Tan
authors: A
authors: A
authors: Yopp
authors: M S
authors: MS
authors: Beg
authors: P
authors: P
authors: Gopal
authors: A G
authors: AG
authors: Singal
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
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