Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
Hepatol Commun. 2023 Jun 22;7(7). doi: 10.1097/HC9.0000000000000190. eCollection 2023 Jul 1.
HCC, the most common form of primary liver cancer, is the fastest rising cause of cancer-related death in the United States. HCC disproportionately affects racial and ethnic minorities in the United States. A practical framework is needed to organize the complex patient, provider, health system, and societal factors that drive these racial and ethnic disparities. In this narrative review, we adapted and applied the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to the HCC care continuum, as a step toward better understanding and addressing existing HCC-related disparities. We first summarize the literature on HCC-related disparities by race and ethnicity organized by the framework's 5 domains (biological, behavioral, physical/built environment, sociocultural environment, and health care system) and 4 levels (individual, interpersonal, community, and societal) of influence. We then offer strategies to guide future research initiatives toward promotion of health equity in HCC care. Clinicians and researchers may help mitigate further inequities and better address racial and ethnic disparities in HCC care by prioritizing the following in HCC research: (1) increasing racial and ethnic minority representation, (2) collecting and reporting HCC-related data by racial and ethnic subgroups, (3) assessing the patient experience of HCC care by race and ethnicity, and (4) evaluating HCC-specific social determinants of health by race and ethnicity. These 4 priorities will help inform the development of future programs and interventions that are tailored to the unique experiences of each racial and ethnic group.
HCC 是原发性肝癌最常见的形式，也是美国癌症相关死亡人数增长最快的原因。HCC 在美国不成比例地影响着少数族裔。需要一个实用的框架来组织复杂的患者、提供者、医疗保健系统和社会因素，这些因素推动了这些种族和族裔差异。在这篇叙述性评论中，我们改编并应用了国家少数民族健康与健康差异研究所（NIMHD）的研究框架，将其应用于 HCC 护理连续体，以更好地理解和解决现有的 HCC 相关差异。我们首先按照框架的 5 个领域（生物、行为、物理/建筑环境、社会文化环境和医疗保健系统）和 4 个影响层次（个人、人际、社区和社会）总结了按种族和族裔组织的 HCC 相关差异文献。然后，我们提供了策略来指导未来的研究计划，以促进 HCC 护理中的健康公平。临床医生和研究人员可以通过以下方式帮助减轻 HCC 护理中的进一步不平等，并更好地解决种族和族裔差异：（1）增加少数族裔的代表性；（2）按种族和族裔亚组收集和报告 HCC 相关数据；（3）评估种族和族裔对 HCC 护理的患者体验；（4）按种族和族裔评估 HCC 特定的健康社会决定因素。这 4 个优先事项将有助于为未来的计划和干预措施的制定提供信息，这些计划和干预措施针对每个种族和族裔的独特经验进行了定制。
