Racial and Ethnic Disparities in Survival Among Patients With Hepatocellular Carcinoma in the United States: A Systematic Review and Meta-Analysis
Nicole E. Rich, Christian Carr, Adam C. Yopp, Jorge A Marrero, Amit G. Singal
Int Med - Digestv & Liver Dis
Background and Aims: Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related death in the United States; however, HCC incidence and mortality are not equally distributed among racial and ethnic groups. Our aim was to characterize the direction and magnitude of racial and ethnic disparities in overall survival and early tumor detection among patients with HCC. Methods: We searched MEDLINE, EMBASE and Cochrane databases from inception through August 2020 for studies reporting HCC outcomes (early stage presentation and overall survival) by race and ethnicity. We calculated pooled hazard ratios (HRs) and odds ratios (ORs) for each racial and ethnic group (White, Black, Hispanic, Asian) using the DerSimonian and Laird method for a random-effects model. Results: We identified 35 articles comprising 563,097 patients (53.0% White, 17.3% Black, 18.4% Hispanic, 5.0% Asian). Compared with White patients, Black patients had worse survival (pooled HR 1.08; 95% CI, 1.05 – 1.12), whereas Hispanic (pooled HR 0.92; 95% CI, 0.87 – 0.97) and Asian (pooled HR 0.81; 95% CI, 0.73 – 0.88) patients had better survival. Among articles reporting tumor stage (n = 20), Black patients had lower odds of early stage HCC compared with White patients (OR, 0.66; 95% CI, 0.54 – 0.78). Conversely, there was no difference in odds of early HCC detection for Asian (OR, 1.01; 95% CI, 0.97 – 1.05) or Hispanic patients (OR, 0.87; 95% CI, 0.74 – 1.01) compared with White patients. The most common limitation of studies was risk of residual confounding from socioeconomic status and liver dysfunction. Conclusions: There are significant racial and ethnic disparities in HCC prognosis in the United States, with Black patients having worse overall survival and Hispanic and Asian patients having better overall survival compared with White patients. Interventions are needed to reduce disparities in early HCC detection to improve HCC prognosis.
Clinical Gastroenterology and Hepatology
https://doi.org/10.1016/j.cgh.2020.12.029
disparities
10.1016/j.cgh.2020.12.029
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Hepatocellular Carcinoma Medicine & Life Sciences 100%
Hispanic Americans Medicine & Life Sciences 49%
European Continental Ancestry Group Medicine & Life Sciences 38%
African Continental Ancestry Group Medicine & Life Sciences 30%
Rich, N. E., Carr, C., Yopp, A. C., Marrero, J. A., & Singal, A. G. (Accepted/In press). Racial and Ethnic Disparities in Survival Among Patients With Hepatocellular Carcinoma in the United States: A Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2020.12.029
Racial and Ethnic Disparities in Survival Among Patients With Hepatocellular Carcinoma in the United States : A Systematic Review and Meta-Analysis. / Rich, Nicole E.; Carr, Christian; Yopp, Adam C.; Marrero, Jorge A; Singal, Amit G.
In: Clinical Gastroenterology and Hepatology, 2021.
Rich, NE, Carr, C, Yopp, AC, Marrero, JA & Singal, AG 2021, 'Racial and Ethnic Disparities in Survival Among Patients With Hepatocellular Carcinoma in the United States: A Systematic Review and Meta-Analysis', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2020.12.029
Rich, Nicole E. ; Carr, Christian ; Yopp, Adam C. ; Marrero, Jorge A ; Singal, Amit G. / Racial and Ethnic Disparities in Survival Among Patients With Hepatocellular Carcinoma in the United States : A Systematic Review and Meta-Analysis. In: Clinical Gastroenterology and Hepatology. 2021.
T1 - Racial and Ethnic Disparities in Survival Among Patients With Hepatocellular Carcinoma in the United States
AU - Rich, Nicole E.
AU - Carr, Christian
AU - Yopp, Adam C.
AU - Marrero, Jorge A
AU - Singal, Amit G.
N1 - Funding Information: Funding Amit G. Singal, Adam C. Yopp, and Nicole E. Rich are supported by National Institutes of Health R01 MD012565. Jorge A. Marrero is supported by National Institutes of Health R01 CA237659-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Conflicts of Interest These authors disclose the following: Jorge Marrero has served as a consultant for Glycotest and received research funding from AstraZeneca. Amit Singal has been on advisory boards and served as a consultant for Wako Diagnostics, Roche, Exact Sciences, Glycotest, Bayer, Genentech, Eisai, Exelixis, BMS, AstraZeneca, and TARGET-RWE. The remaining authors disclose no conflicts. Funding Information: Funding Amit G. Singal, Adam C. Yopp, and Nicole E. Rich are supported by National Institutes of Health R01 MD012565. Jorge A. Marrero is supported by National Institutes of Health R01 CA237659-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2020 AGA Institute
N2 - Background and Aims: Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related death in the United States; however, HCC incidence and mortality are not equally distributed among racial and ethnic groups. Our aim was to characterize the direction and magnitude of racial and ethnic disparities in overall survival and early tumor detection among patients with HCC. Methods: We searched MEDLINE, EMBASE and Cochrane databases from inception through August 2020 for studies reporting HCC outcomes (early stage presentation and overall survival) by race and ethnicity. We calculated pooled hazard ratios (HRs) and odds ratios (ORs) for each racial and ethnic group (White, Black, Hispanic, Asian) using the DerSimonian and Laird method for a random-effects model. Results: We identified 35 articles comprising 563,097 patients (53.0% White, 17.3% Black, 18.4% Hispanic, 5.0% Asian). Compared with White patients, Black patients had worse survival (pooled HR 1.08; 95% CI, 1.05 – 1.12), whereas Hispanic (pooled HR 0.92; 95% CI, 0.87 – 0.97) and Asian (pooled HR 0.81; 95% CI, 0.73 – 0.88) patients had better survival. Among articles reporting tumor stage (n = 20), Black patients had lower odds of early stage HCC compared with White patients (OR, 0.66; 95% CI, 0.54 – 0.78). Conversely, there was no difference in odds of early HCC detection for Asian (OR, 1.01; 95% CI, 0.97 – 1.05) or Hispanic patients (OR, 0.87; 95% CI, 0.74 – 1.01) compared with White patients. The most common limitation of studies was risk of residual confounding from socioeconomic status and liver dysfunction. Conclusions: There are significant racial and ethnic disparities in HCC prognosis in the United States, with Black patients having worse overall survival and Hispanic and Asian patients having better overall survival compared with White patients. Interventions are needed to reduce disparities in early HCC detection to improve HCC prognosis.
AB - Background and Aims: Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related death in the United States; however, HCC incidence and mortality are not equally distributed among racial and ethnic groups. Our aim was to characterize the direction and magnitude of racial and ethnic disparities in overall survival and early tumor detection among patients with HCC. Methods: We searched MEDLINE, EMBASE and Cochrane databases from inception through August 2020 for studies reporting HCC outcomes (early stage presentation and overall survival) by race and ethnicity. We calculated pooled hazard ratios (HRs) and odds ratios (ORs) for each racial and ethnic group (White, Black, Hispanic, Asian) using the DerSimonian and Laird method for a random-effects model. Results: We identified 35 articles comprising 563,097 patients (53.0% White, 17.3% Black, 18.4% Hispanic, 5.0% Asian). Compared with White patients, Black patients had worse survival (pooled HR 1.08; 95% CI, 1.05 – 1.12), whereas Hispanic (pooled HR 0.92; 95% CI, 0.87 – 0.97) and Asian (pooled HR 0.81; 95% CI, 0.73 – 0.88) patients had better survival. Among articles reporting tumor stage (n = 20), Black patients had lower odds of early stage HCC compared with White patients (OR, 0.66; 95% CI, 0.54 – 0.78). Conversely, there was no difference in odds of early HCC detection for Asian (OR, 1.01; 95% CI, 0.97 – 1.05) or Hispanic patients (OR, 0.87; 95% CI, 0.74 – 1.01) compared with White patients. The most common limitation of studies was risk of residual confounding from socioeconomic status and liver dysfunction. Conclusions: There are significant racial and ethnic disparities in HCC prognosis in the United States, with Black patients having worse overall survival and Hispanic and Asian patients having better overall survival compared with White patients. Interventions are needed to reduce disparities in early HCC detection to improve HCC prognosis.
KW - disparities
KW - ethnicity
KW - liver cancer
KW - race
KW - survival
U2 - 10.1016/j.cgh.2020.12.029
DO - 10.1016/j.cgh.2020.12.029
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology