title: Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012.
abstract: OBJECTIVE
  To describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry.
  
  
  METHODS
  Invasive cases of primary hepatocellular carcinoma,n= 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White,n= 12710), Hispanic (n= 8500), Chinese (n= 2723), non-Hispanic Black (Black,n= 2609), Vietnamese (n= 2063), Filipino (n= 1479), Korean (n= 1099), Japanese (n= 658), American Indian/Alaskan Native (AIAN,n= 281), Laotian/Hmong (n= 244), Cambodian (n= 233), South Asian (n= 190), Hawai`ian/Pacific Islander (n= 172), Thai (n= 95), and Other Asian (n= 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.
  
  
  RESULTS
  After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.
  
  
  CONCLUSIONS
  Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Susan L
authors: SL
authors: Stewart
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Sandy L
authors: SL
authors: Kwong
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Christopher L
authors: CL
authors: Bowlus
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Tung T
authors: TT
authors: Nguyen
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Annette E
authors: AE
authors: Maxwell
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Roshan
authors: R
authors: Bastani
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Eric W
authors: EW
authors: Chak
authors: Susan L Stewart, Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817, United States.
authors: Moon S
authors: MS
authors: Chen
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001213:Asian; D002140:California; D006528:Carcinoma, Hepatocellular / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D005843:Geography; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class; D016896:Treatment Outcome; D014481:United States
keywords: Disparities; Hepatocellular carcinoma; Liver cancer; Survival; Treatment