Division of Gastroenterology and Hepatology Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA.
Hepatol Commun. 2023 Feb 9;7(3):e0058. doi: 10.1097/HC9.0000000000000058. eCollection 2023 Mar 1.
The social determinants of health can pose barriers to accessing cancer screening and treatment and have been associated with cancer mortality. However, it is not clear whether area deprivation is independently associated with mortality in HCC and cholangiocarcinoma when controlling for individual-level social determinants of health.
The cohort included individuals over 18 years old diagnosed with HCC (N=3460) or cholangiocarcinoma (N=781) and reported to the Indiana State Cancer Registry from 2009 to 2017. Area disadvantage was measured using the social deprivation index (SDI). SDI was obtained by linking addresses to the American Community Survey. Individual social determinants of health included race, ethnicity, sex, marital status, and insurance type. The primary outcome was mortality while controlling for SDI and individual social determinants of health by means of Cox proportional hazard modeling. In HCC, living in a neighborhood in the fourth quartile of census-track SDI (most deprived) was associated with higher mortality (HR: 1.14, 95% CI, 1.003-1.30, p=0.04) than living in a first quartile SDI neighborhood. Being uninsured (HR: 1.64, 95% CI, 1.30-2.07, p<0.0001) and never being married (HR: 1.31, 95% CI, 1.15-1.48, p<0.0001) were also associated with mortality in HCC. In cholangiocarcinoma, SDI was not associated with mortality.
Social deprivation was independently associated with mortality in HCC but not cholangiocarcinoma. Further research is needed to better understand how to intervene on both area and individual social determinants of health and develop interventions to address these disparities.
健康的社会决定因素可能会成为获得癌症筛查和治疗的障碍，并与癌症死亡率有关。然而，在控制个体健康的社会决定因素后，尚不清楚区域贫困是否与 HCC 和胆管癌的死亡率独立相关。
该队列纳入了 2009 年至 2017 年期间向印第安纳州癌症登记处报告的年龄在 18 岁以上的 HCC（N=3460）或胆管癌（N=781）患者。使用社会剥夺指数（SDI）衡量区域劣势。SDI 通过将地址与美国社区调查相联系获得。个体健康的社会决定因素包括种族、民族、性别、婚姻状况和保险类型。主要结果是在控制 SDI 和个体健康的社会决定因素后通过 Cox 比例风险模型计算的死亡率。在 HCC 中，与居住在 SDI （最贫困）第四四分位数的社区相比，居住在第一四分位数 SDI 社区的死亡率更高（HR：1.14，95%CI，1.003-1.30，p=0.04）。未参保（HR：1.64，95%CI，1.30-2.07，p<0.0001）和从未结婚（HR：1.31，95%CI，1.15-1.48，p<0.0001）也与 HCC 的死亡率相关。在胆管癌中，SDI 与死亡率无关。
社会剥夺与 HCC 的死亡率独立相关，但与胆管癌的死亡率无关。需要进一步研究以更好地了解如何干预区域和个体健康的社会决定因素，并制定干预措施来解决这些差异。
