title: Disentangling the effects of race and socioeconomic factors on liver transplantation rates for hepatocellular carcinoma.
abstract: Liver transplantation is the most effective treatment for hepatocellular carcinoma (HCC) in eligible patients, but is not accessed equally by all. We explored the effects of race and socioeconomic factors on transplantation for HCC while controlling for stage, resection status, and transplant candidacy.
  
  
  
  All HCC patients, 2003-2013, were retrospectively analyzed using multivariate analysis to explore differences in transplantation rates among cohorts.
  
  
  
  Of 3078 HCC patients, 754 (24%) were considered transplant eligible. Odds of transplantation were significantly higher for those with commercial insurance (OR = 1.99, 95% CI [1.42, 2.79]) and lower for black patients (OR = 0.55, 95% CI [0.33, 0.91]). Asians were more likely to be resected than white patients with similarly staged tumors and transplant criteria (p < 0.001). Patients not listed for transplantation for non-medical reasons were more likely to be government-insured (p = 0.02) and not white (p = 0.05). No step along the transplantation pathway was identified as the dominant hurdle.
  
  
  
  Patients who are black or government-insured are significantly less likely to undergo transplantation for HCC despite controlling for tumor stage, resection status, and transplant eligibility. Asian patients have higher rates of hepatic resection, but also appear to have lower transplantation rates beyond this effect.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, New York, NY, USA.
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.affiliation: Department of Population, Health Science and Policy, New York, NY, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Suprun
authors.affiliation: Department of Strategic Planning, New York, NY, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Sofianou
authors.affiliation: Division of Surgical Oncology, Department of Surgery, New York, NY, USA.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Berger
authors.affiliation: Department of Neurosurgery, New York, NY, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tedjasukmana
authors.affiliation: Ross University, Roseau, Dominica.
authors.forename: Zennur
authors.initials: Z
authors.lastname: Sekendiz
authors.affiliation: Department of Population, Health Science and Policy, New York, NY, USA.
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.affiliation: The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Myron E
authors.initials: ME
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: access to care; disparity; hepatocellular carcinoma; liver transplantation; minority health; socioeconomic