title: Race not rural residency is predictive of surgical treatment for hepatocellular carcinoma: Analysis of the Texas Cancer Registry.
abstract: OBJECTIVE
  Rural patients have poor access to specialists and are less likely to receive evidence-based cancer care. We hypothesized that hepatocellular carcinoma (HCC) patients from rural counties in Texas would be less likely to receive surgical therapy than those from urban areas.
  
  
  METHODS
  The Texas Cancer Registry was queried (2000-2008). County-level data included "rural or urban" designation and income variables derived by zip code. Surgical intervention included: (i) ablation, (ii) resection-partial or total lobectomy, or (iii) transplantation. A multinomial logistic regression was created to determine predictors of intervention.
  
  
  RESULTS
  Five thousand thirty seven HCC patients were identified (86% urban) for study. A multinomial regression demonstrated, older age, African-American race, and lower income reduced the likelihood of ablation. Younger age, female gender, Caucasian, and Asian/other race predicted surgical resection, or transplantation. Hispanic race was associated with lower likelihood of resection (RRR 0.75) and transplantation (RRR 0.74), whereas African-American race was associated with pronounced decrease for transplantation (RRR 0.48). Area of residency was not predictive of intervention.
  
  
  CONCLUSIONS
  Rural residency did not decrease the likelihood of surgical intervention for hepatocellular carcinoma. Race and income continue to be associated with significant treatment disparity. Additional investigation should focus on factors that govern the selection of resection or transplantation for potentially eligible patients.
authors.affiliation: UTHealth Center for Clinical and Translational Sciences, Houston, Texas.|University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Zeinab M
authors.initials: ZM
authors.lastname: Alawadi
authors.affiliation: UTHealth Center for Clinical and Translational Sciences, Houston, Texas.|University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Uma R
authors.initials: UR
authors.lastname: Phatak
authors.affiliation: UTHealth Center for Clinical and Translational Sciences, Houston, Texas.|University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Tien C
authors.initials: TC
authors.lastname: Ko
authors.affiliation: UTHealth Center for Clinical and Translational Sciences, Houston, Texas.|University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wray
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D044469:Racial Groups; D012042:Registries; D012424:Rural Population / Q000706:statistics & numerical data*; D013781:Texas / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: ablation; disparity; hepatocellular carcinoma; surgical resection; transplantation