Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Surgery, Maimonides Medical Center, Brooklyn, NY.
Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
Surgery. 2020 Jul;168(1):49-55. doi: 10.1016/j.surg.2020.03.017. Epub 2020 May 13.
Hepatitis C affects racial minorities disproportionately and is greatest among the black population. The incidence of hepatocellular carcinoma has increased with the largest increase observed in black and Hispanic populations, but limited data remain on whether hepatitis C hepatocellular carcinoma in racial-ethnic minorities have the same utilization of services compared with the white population.
We used the database of the National Inpatient Sample to identify hepatitis C-hepatocellular carcinoma patients (N = 200,163) who underwent liver transplantation (n = 11,491), liver resection (n = 4,896), or ablation of liver lesions (n = 6,933) from 2005 to 2015. We estimated utilization over time and assessed differences in utilization and inpatient mortality across patient characteristics.
In multivariate analysis, factors associated with utilization of services included treatment year, sex, race, insurance status, hospital type, and comorbidity burden, with black and Hispanic patients having statistically significantly decreased utilization. Factors associated with inpatient mortality included treatment year, sex, race, insurance status, hospital type, hospital region, and comorbidity burden, with black patients having a statistically significantly greater risk of inpatient mortality.
We identified racial and socioeconomic factors which were associated with utilization of services and inpatient mortality for patients with hepatitis C hepatocellular carcinoma. Blacks were especially disadvantaged in the receipt of care. Further work to abrogate these findings is imperative to ensure equitable provision of surgical therapies.
丙型肝炎在少数族裔中发病率不成比例，在黑人群体中发病率最高。肝细胞癌的发病率随着黑人和西班牙裔人群的发病率增加而增加，但关于少数族裔丙型肝炎相关肝细胞癌患者与白人相比，服务利用率是否相同的数据仍然有限。
我们使用国家住院患者样本数据库，确定了 2005 年至 2015 年间接受肝移植（n=11491）、肝切除术（n=4896）或肝脏病变消融术（n=6933）的丙型肝炎-肝细胞癌患者（n=200163）。我们估计了随时间的利用率，并评估了不同患者特征下的利用率和住院死亡率差异。
多变量分析中，与服务利用率相关的因素包括治疗年份、性别、种族、保险状况、医院类型和合并症负担，黑人患者和西班牙裔患者的利用率明显下降。与住院死亡率相关的因素包括治疗年份、性别、种族、保险状况、医院类型、医院区域和合并症负担，黑人患者的住院死亡率明显更高。
我们确定了与丙型肝炎相关肝细胞癌患者服务利用率和住院死亡率相关的种族和社会经济因素。黑人在获得护理方面处于特别不利的地位。为了消除这些发现，必须进一步努力，以确保公平提供手术治疗。
