Division of Abdominal Transplantation, Department of Surgery, University of Kentucky, Lexington, KY.
Division of Abdominal Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Surgery. 2024 Dec;176(6):1754-1760. doi: 10.1016/j.surg.2024.08.020. Epub 2024 Sep 19.
Orthotopic liver transplantation is the recommended treatment option for patients with early-stage hepatocellular carcinoma and concomitant cirrhosis. Waitlist candidacy can be affected by social determinants of health that vary across races and ethnicities. Our study sought to evaluate whether racial/ethnic disparities exist in access to orthotopic liver transplantation in patients with hepatocellular carcinoma.
The National Cancer Database participant use file was used to analyze data between 2004 and 2020. Patients 18-70 years of age with TNM clinical stage I and II hepatocellular carcinoma who received either orthotopic liver transplantation or liver directed/nonsurgical therapies were included. Baseline demographic variables and treatment modalities were collected. Patients were assigned fixed categories on the basis of race and ethnicity. Descriptive statistics, multivariable logistical regressions, effects modification analysis, and propensity matching were used.
There were 23,313 non-Hispanic White, 5,215 non-Hispanic Black, 5,581 Hispanic, and 2,768 other patients included in this analysis. Significant socioeconomic variation was observed across races. Non-Hispanic White patients were more likely to undergo orthotopic liver transplantation than non-Hispanic Black patients. The proportion of patients insured by Medicare was the same between non-Hispanic White and non-Hispanic Black patients. There was a graeter proportion of non-Hispanic Black patients with Medicaid compared with non-Hispanic White patients, whereas a lower proportion of non-Hispanic Black patients were insured via private insurance compared with non-Hispanic White patients. Effect modification analysis showed the non-Hispanic Black patients were less likely to undergo orthotopic liver transplantation for those with private and Medicare coverage compared with non-Hispanic White patients. Propensity matching showed a significantly decreased rate of orthotopic liver transplantation in non-Hispanic Black patients compared with non-Hispanic White patients.
Non-Hispanic Black patients were less likely to undergo orthotopic liver transplantation for early-stage hepatocellular carcinoma, despite adjusting for cancer stage and socioeconomic factors, compared with non-Hispanic White patients. Social determinants of health were associated with the probability of undergoing orthotopic liver transplantation. Understanding disparities related to social determinants of health will help guide health policy changes and improved access to care.
原位肝移植是早期肝细胞癌合并肝硬化患者的推荐治疗选择。候补资格可能受到不同种族和族裔之间的健康社会决定因素的影响。我们的研究旨在评估在肝细胞癌患者中，接受原位肝移植的机会是否存在种族/民族差异。
使用国家癌症数据库参与者使用文件分析了 2004 年至 2020 年的数据。纳入年龄在 18-70 岁之间、TNM 临床分期 I 和 II 期肝细胞癌患者，接受原位肝移植或肝定向/非手术治疗。收集基线人口统计学变量和治疗方式。根据种族和族裔将患者分为固定类别。使用描述性统计、多变量逻辑回归、效应修饰分析和倾向匹配。
本分析纳入了 23313 名非西班牙裔白人、5215 名非西班牙裔黑人、5581 名西班牙裔和 2768 名其他患者。不同种族之间存在显著的社会经济差异。非西班牙裔白人患者接受原位肝移植的可能性高于非西班牙裔黑人患者。非西班牙裔白人和非西班牙裔黑人患者的医疗保险参保比例相同。与非西班牙裔白人患者相比，非西班牙裔黑人患者中拥有医疗补助的比例更高，而拥有私人保险的非西班牙裔黑人患者比例较低。效应修饰分析表明，与非西班牙裔白人患者相比，拥有私人保险和医疗保险的非西班牙裔黑人患者接受原位肝移植的可能性较小。倾向匹配显示，与非西班牙裔白人患者相比，非西班牙裔黑人患者接受原位肝移植的比例显著降低。
尽管调整了癌症分期和社会经济因素，与非西班牙裔白人患者相比，非西班牙裔黑人患者接受早期肝细胞癌原位肝移植的可能性较低。健康社会决定因素与接受原位肝移植的概率相关。了解与健康社会决定因素相关的差异将有助于指导医疗政策的改变和改善获得护理的机会。
