Racial Disparities in In-Hospital Outcomes for Hepatocellular Carcinoma

Abstract

Background and Aims: Hepatocellular cancer (HCC) is increasing in incidence, contributing to morbidity and mortality. Racial disparities in therapeutic interventions and hospitalization outcomes have not been studied previously. Methods: Using the 2011 Nationwide Inpatient Sample, the largest all-payer database of hospitalizations in the United States, we identified patients with HCC-related admissions using previously validated ICD-9-CM codes. Among these, we also identified those that were procedure-related (associated with liver transplantation, hepatic resection, radiofrequency ablation or transarterial chemoembolization (TACE). Multivariate regression was performed to identify the contribution of race to therapeutic interventions and outcomes. Results: A total of 22,933 HCC-related hospitalizations were included of which 10,285 (45%) were procedure related. Blacks had a smaller proportion (35%) of procedure-related HCC hospitalizations compared to 46% for whites [Odds ratio (OR) 0.65, 95% confidence interval (CI) 0.49 – 0.86]. Specifically, blacks had lower odds of liver transplantation (OR 0.43, 95% CI 0.26-0.71), hepatic resection (OR 0.57, 95% CI 0.33-0.98) and ablation (0.46, 95% CI 0.29-0.74, p=0.002) when compared to whites. Overall, 10.9% of HCC-related admissions resulted in death among blacks compared to 6.4% among whites (OR 1.58, 95% CI 1.12 – 2.24). Conclusion: Among HCC-related hospitalizations, blacks were less likely to receive liver transplantation, hepatic resection, and ablation when compared to whites and had higher in-patient mortality. Identifying racial disparities in health care is a necessary first step to appropriately address and eliminate them.