title: Racial Disparities in Inhospital Outcomes for Hepatocellular Carcinoma in the United States.
abstract: OBJECTIVE
  To study racial disparities in therapeutic interventions and hospitalization outcomes for hepatocellular cancer (HCC) in the United States.
  
  
  METHODS
  Using the 2011 Nationwide Inpatient Sample (comprising hospitalizations between January 1 and December 31, 2011), we identified patients with HCC-related admissions using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes. Among these, we also identified those that were procedure-related (associated with liver transplantation, hepatic resection, radiofrequency ablation, or transarterial chemoembolization). Multivariate regression was performed to identify the contribution of race to therapeutic interventions and outcomes.
  
  
  RESULTS
  A total of 22,933 HCC-related hospitalizations were included, of which 10,285 were procedure related (45%). Blacks had a smaller proportion (35%) of procedure-related HCC hospitalizations than did whites (46%) (odds ratio [OR], 0.65; 95% CI, 0.49-0.86). Specifically, blacks had lower odds of liver transplantation (OR, 0.43; 95% CI, 0.26-0.71), hepatic resection (OR, 0.57; 95% CI, 0.33-0.98), and ablation (OR, 0.46; 95% CI, 0.29-0.74) (P=.002) than did whites. Overall, 10.9% of HCC-related admissions resulted in death in blacks as compared with 6.4% in whites (OR, 1.58; 95% CI, 1.12-2.24).
  
  
  CONCLUSIONS
  Among patients admitted for HCC-related hospitalizations, blacks were less likely to receive liver transplantation, hepatic resection, and ablation than whites and had higher inhospital mortality. Identifying racial disparities in health care is a necessary first step to appropriately address and eliminate them.
authors: Gastroenterology Division, Massachusetts General Hospital, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors: Ruma
authors: R
authors: Rajbhandari
authors: Harvard Medical School, Boston, MA.
authors: Rachel E
authors: RE
authors: Simon
authors: Gastroenterology Division, Massachusetts General Hospital, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: rtchung@partners.org.
authors: Raymond T
authors: RT
authors: Chung
authors: Gastroenterology Division, Massachusetts General Hospital, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors: Ashwin N
authors: AN
authors: Ananthakrishnan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American