Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas, USA.
Inovalon Inc., Bowie, Maryland, USA.
Hepatol Commun. 2024 Oct 10;8(11). doi: 10.1097/HC9.0000000000000517. eCollection 2024 Nov 1.
The impact of clinical factors and social determinants of health on treatment patterns and health care costs among patients with HCC is unknown.
Using 100% Medicare Fee-For-Service claims and a commercial multipayor claims database, we identified patients diagnosed with HCC from January 1, 2017, to December 31, 2020. Surveillance receipt was defined 12 months prior to HCC diagnosis, whereas treatment and health care costs were assessed post-HCC diagnosis. Multinomial logistic regression was used to assess the association between demographics, social determinants of health, and surveillance or HCC treatment. Multivariable generalized linear regression was used to identify factors associated with total health care costs.
Of the 32,239 patients with HCC (mean age 68 y, 67% male, 73% White), 70% received surveillance and only half (51%) received any treatment. Curative treatment receipt was higher among those with prior surveillance (24% with CT/MRI and 18% with ultrasound vs. 9% with no surveillance). Curative treatment was independently associated with HCC surveillance and inversely associated with Black race, lower education level, and diagnosis in the year 2020 (COVID-19 year). Higher health care costs were independently associated with Black race, low English proficiency, living alone, and diagnosis in 2018-2020, and inversely associated with CT/MRI-based surveillance.
Race and social determinants of health were independently associated with curative treatment receipt and health care costs. Increasing access to high-quality HCC surveillance may improve treatment receipt and reduce health disparities among patients with HCC.
临床因素和健康的社会决定因素对 HCC 患者的治疗模式和医疗保健费用的影响尚不清楚。
使用 100%的医疗保险按服务付费索赔和商业多支付者索赔数据库，我们从 2017 年 1 月 1 日至 2020 年 12 月 31 日确定了诊断为 HCC 的患者。监测的接收定义为 HCC 诊断前 12 个月，而治疗和医疗保健费用则在 HCC 诊断后评估。使用多项逻辑回归评估人口统计学，健康的社会决定因素与监测或 HCC 治疗之间的关联。使用多变量广义线性回归确定与总医疗保健费用相关的因素。
在 32239 名 HCC 患者中（平均年龄 68 岁，67%为男性，73%为白人），70%接受了监测，只有一半（51%）接受了任何治疗。有监测的患者接受根治性治疗的比例较高（CT/MRI 有 24%，超声有 18%，无监测有 9%）。根治性治疗与 HCC 监测独立相关，与黑人种族，较低的教育程度和 2020 年的诊断呈负相关（COVID-19 年）。较高的医疗保健费用与黑人种族，英语水平低，独居和 2018-2020 年的诊断独立相关，与基于 CT/MRI 的监测呈负相关。
种族和健康的社会决定因素与根治性治疗的接受和医疗保健费用独立相关。增加高质量 HCC 监测的机会可能会改善治疗的接受率并减少 HCC 患者的健康差异。
