Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.
Gut Liver. 2022 Nov 15;16(6):976-984. doi: 10.5009/gnl210567. Epub 2022 Apr 22.
BACKGROUND/AIMS: We studied the impact of socioeconomic status (SES) on mortality in hepatocellular carcinoma patients and analyzed the effect of SES on initial treatment allocation.
A cohort study was conducted using data from the National Health Insurance Service- National Sample Cohort of Korea. A total of 3,032 hepatocellular carcinoma patients who were newly diagnosed between January 2003 and December 2013 were included. Income level was categorized as Medical Aid and ≤30th, 31st-70th, or >70th percentile as an SES indicator.
The proportion of Medical Aid was 4.3%. The highest risks of all-cause mortality associated with Medical Aid were evident in the transcatheter arterial chemoembolization group (fully adjusted hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04) but not in the curative treatment group. An association between the lower-income percentile and higher liver cancer-specific mortality was also observed, except in the curative treatment group. The association between income percentile and all-cause mortality was nonlinear, with a stronger association in the lower-income percentiles than in the higher income percentiles (p-value for nonlinear spline terms <0.05).
Patients in the lower SES group, especially patients not eligible for curative treatment, had an increased risk of mortality. In addition, the association between SES and the risk for mortality was stronger in the lower-income percentile than in the moderate to higher income percentiles.
背景/目的：本研究旨在探讨社会经济地位（SES）对肝细胞癌患者死亡率的影响，并分析 SES 对初始治疗分配的影响。
本研究采用了韩国国家健康保险服务-国家样本队列的数据进行队列研究。共纳入了 3032 例于 2003 年 1 月至 2013 年 12 月期间新诊断为肝细胞癌的患者。收入水平分为医疗补助和 ≤30 分位、31 分位至 70 分位和>70 分位三个层次，作为 SES 指标。
医疗补助的比例为 4.3%。在经导管动脉化疗栓塞治疗组（校正后 HR，2.40；95%CI，1.25 至 4.58）、其他治疗组（校正后 HR，2.86；95%CI，1.85 至 4.41）和未治疗组（校正后 HR，2.69；95%CI，1.79 至 4.04）中，医疗补助与全因死亡率的相关性最高，但在根治性治疗组中则不然。除了根治性治疗组外，较低的收入百分位与较高的肝癌特异性死亡率之间也存在关联。收入百分位与全因死亡率之间的关系是非线性的，较低收入百分位的相关性比较高收入百分位更强（非线性样条术语的 p 值<0.05）。
SES 较低的患者，特别是不符合根治性治疗条件的患者，死亡风险增加。此外，SES 与死亡率之间的关联在较低收入百分位比中等到较高收入百分位更强。
