Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Stud
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ORIGINAL ARTICLE – HEALTH SERVICES RESEARCH AND GLOBAL ONCOLOGY
Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Study Joshua P. Kronenfeld, MD1, Emily L. Ryon, MD MPH1, David Goldberg, MD MSCE2, Rachel M. Lee, MD MSPH3, Adam Yopp, MD4, Annie Wang, MD5, Ann Y. Lee, MD5, Sommer Luu, BS6, Cary Hsu, MD6, Eric Silberfein, MD6, Maria C. Russell, MD3, Alan S. Livingstone, MD1, Nipun B. Merchant, MD1, and Neha Goel, MD1 1
Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; 2Division of Digestive Health and Liver Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; 3Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA; 4Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX; 5Division of Surgical Oncology, Department of Surgery, NYU Langone Health, New York, NY; 6Division of Surgical Oncology, Department of Surgery, Baylor College of Medicine, Houston, TX
ABSTRACT Background. While hepatocellular carcinoma (HCC) is ideally diagnosed outpatient by screening at-risk patients, many are diagnosed in Emergency Departments (ED) due to undiagnosed liver disease and/or limited access-tohealthcare. This study aims to identify sociodemographic/clinical factors associated with being diagnosed with HCC in the ED to identify patients who may benefit from improved access-to-care. Methods. HCC patients diagnosed between 2012 and 2014 in the ED or an outpatient setting [Primary Care Physician (PCP) or hepatologist] were identified from the US Safety-Net Collaborative database and underwent retrospective chart-review. Multivariable regression identified predictors for an ED diagnosis. Results. Among 1620 patients, median age was 60, 68% were diagnosed outpatient, and 32% were diagnosed in the ED. ED patients were more likely male, Black/Hispanic, uninsured, and presented with more decompensated liver disease, aggressive features, and advanced clinical stage.
Ó Society of Surgical Oncology 2020 First Received: 15 June 2020 Accepted: 30 August 2020 N. Goel, MD e-mail: [email protected]
On multivariable regression, controlling for age, gender, race/ethnicity, poverty, insurance, and PCP/navigator access, predictors for ED diagnosis were male (odds ratio [OR] 1.6, 95% confidence interval [CI]: 1.1–2.2, p = 0.010), black (OR 1.7, 95% CI: 1.2–2.3, p = 0.002), Hispanic (OR 1.6, 95% CI: 1.1–2.6, p = 0.029), [ 25% below poverty line (OR 1.4, 95% CI: 1.1–1.9, p = 0.019), uninsured (OR 3.9, 95% CI: 2.4–6.1, p \ 0.001), and lack of PCP (OR 2.3, 95% CI: 1.5–3.6, p \ 0.001) or navigator (OR 1.8, 95% CI: 1.3–2.5, p = 0.001). Conclusions. The sociodemographic/clinical profile of patients diagnosed with HCC in EDs differs significantly from those diagnosed outpatient. ED patients were more likely racial/ethnic minorities, uninsured
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