Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma
Background Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status. Aims Characterize racial/ethnic and insurance status in early tumor detection, recei...
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| Veröffentlicht in: | Digestive diseases and sciences 2020-06, Vol.65 (6), p.1669-1678 |
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| creator | Scaglione, Steve Adams, William Caines, Allyce Devlin, Pauline Mittal, Sahil Singal, Amit G. Parikh, Neehar D. |
| description | Background
Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status.
Aims
Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA.
Study
We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups.
Results
Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival.
Conclusions
Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients. |
| doi_str_mv | 10.1007/s10620-019-05890-2 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7603399</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A712935914</galeid><sourcerecordid>A712935914</sourcerecordid><originalsourceid>FETCH-LOGICAL-c541t-248747ccf59b916660e1dee3b31e24224623035433f44aaaaad9e64ed49cedb73</originalsourceid><addsrcrecordid>eNp9Uk1vEzEQtRCIlsAf4IBW4sJlW4_t9cYXpDQqtFKlIj7OluOdTVzt2sH2UvXf45DQUoSwDx553ryZN3qEvAZ6ApS2pwmoZLSmoGrazBWt2RNyDE3La9bI-VNyTEGWGEAekRcp3VBKVQvyOTniIAWnXB6TsEgpWGeyC746w3yL6KvPxuLped54Z12-q4zvqkufpmi8xepLNnlK1a3Lm-p6yjaMmCrnq0-FA30-ZC5wa3KwOAzTYGK1NNE6H0bzkjzrzZDw1eGdkW8fzr8uL-qr64-Xy8VVbRsBuWZi3orW2r5RKwVSSorQIfIVB2SCMSFZmb8RnPdCmN3pFEqBnVAWu1XLZ-T9nnc7rUbsbJksmkFvoxtNvNPBOP04491Gr8MP3UrKuVKF4N2BIIbvE6asR5d2eozHMCVd-s-hBVEWOSNv_4LehCn6Ik8zQdkcKAj1gFqbAbXzfSh97Y5UL1pgijcKdlwn_0CV2-HobPDYu_L_qIDtC2wMKUXs7zUC1Tub6L1NdLGJ_mWTMvqMvPlzO_clv31RAHwPSCXl1xgfJP2H9id13sha</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2402810149</pqid></control><display><type>article</type><title>Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Scaglione, Steve ; Adams, William ; Caines, Allyce ; Devlin, Pauline ; Mittal, Sahil ; Singal, Amit G. ; Parikh, Neehar D.</creator><creatorcontrib>Scaglione, Steve ; Adams, William ; Caines, Allyce ; Devlin, Pauline ; Mittal, Sahil ; Singal, Amit G. ; Parikh, Neehar D.</creatorcontrib><description>Background
Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status.
Aims
Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA.
Study
We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups.
Results
Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival.
Conclusions
Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients.</description><identifier>ISSN: 0163-2116</identifier><identifier>ISSN: 1573-2568</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-019-05890-2</identifier><identifier>PMID: 31643036</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ablation (Surgery) ; Biochemistry ; Carcinoma, Hepatocellular - economics ; Carcinoma, Hepatocellular - epidemiology ; Carcinoma, Hepatocellular - ethnology ; Carcinoma, Hepatocellular - therapy ; Care and treatment ; Cohort Studies ; Cultural differences ; Ethnicity ; Female ; Gastroenterology ; Healthcare Disparities - ethnology ; Hepatology ; Hepatoma ; Humans ; Insurance ; Insurance, Health ; Liver ; Liver cancer ; Liver Neoplasms - economics ; Liver Neoplasms - epidemiology ; Liver Neoplasms - ethnology ; Liver Neoplasms - therapy ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Oncology ; Original Article ; Patient outcomes ; Patients ; Prognosis ; Property and casualty insurance industry ; Race ; Racial Groups ; Retrospective Studies ; Transplant Surgery ; Transplantation ; United States - epidemiology</subject><ispartof>Digestive diseases and sciences, 2020-06, Vol.65 (6), p.1669-1678</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019</rights><rights>COPYRIGHT 2020 Springer</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-248747ccf59b916660e1dee3b31e24224623035433f44aaaaad9e64ed49cedb73</citedby><cites>FETCH-LOGICAL-c541t-248747ccf59b916660e1dee3b31e24224623035433f44aaaaad9e64ed49cedb73</cites><orcidid>0000-0003-0478-1089</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-019-05890-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-019-05890-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31643036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scaglione, Steve</creatorcontrib><creatorcontrib>Adams, William</creatorcontrib><creatorcontrib>Caines, Allyce</creatorcontrib><creatorcontrib>Devlin, Pauline</creatorcontrib><creatorcontrib>Mittal, Sahil</creatorcontrib><creatorcontrib>Singal, Amit G.</creatorcontrib><creatorcontrib>Parikh, Neehar D.</creatorcontrib><title>Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background
Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status.
Aims
Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA.
Study
We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups.
Results
Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival.
Conclusions
Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients.</description><subject>Ablation (Surgery)</subject><subject>Biochemistry</subject><subject>Carcinoma, Hepatocellular - economics</subject><subject>Carcinoma, Hepatocellular - epidemiology</subject><subject>Carcinoma, Hepatocellular - ethnology</subject><subject>Carcinoma, Hepatocellular - therapy</subject><subject>Care and treatment</subject><subject>Cohort Studies</subject><subject>Cultural differences</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Healthcare Disparities - ethnology</subject><subject>Hepatology</subject><subject>Hepatoma</subject><subject>Humans</subject><subject>Insurance</subject><subject>Insurance, Health</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - economics</subject><subject>Liver Neoplasms - epidemiology</subject><subject>Liver Neoplasms - ethnology</subject><subject>Liver Neoplasms - therapy</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Property and casualty insurance industry</subject><subject>Race</subject><subject>Racial Groups</subject><subject>Retrospective Studies</subject><subject>Transplant Surgery</subject><subject>Transplantation</subject><subject>United States - epidemiology</subject><issn>0163-2116</issn><issn>1573-2568</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9Uk1vEzEQtRCIlsAf4IBW4sJlW4_t9cYXpDQqtFKlIj7OluOdTVzt2sH2UvXf45DQUoSwDx553ryZN3qEvAZ6ApS2pwmoZLSmoGrazBWt2RNyDE3La9bI-VNyTEGWGEAekRcp3VBKVQvyOTniIAWnXB6TsEgpWGeyC746w3yL6KvPxuLped54Z12-q4zvqkufpmi8xepLNnlK1a3Lm-p6yjaMmCrnq0-FA30-ZC5wa3KwOAzTYGK1NNE6H0bzkjzrzZDw1eGdkW8fzr8uL-qr64-Xy8VVbRsBuWZi3orW2r5RKwVSSorQIfIVB2SCMSFZmb8RnPdCmN3pFEqBnVAWu1XLZ-T9nnc7rUbsbJksmkFvoxtNvNPBOP04491Gr8MP3UrKuVKF4N2BIIbvE6asR5d2eozHMCVd-s-hBVEWOSNv_4LehCn6Ik8zQdkcKAj1gFqbAbXzfSh97Y5UL1pgijcKdlwn_0CV2-HobPDYu_L_qIDtC2wMKUXs7zUC1Tub6L1NdLGJ_mWTMvqMvPlzO_clv31RAHwPSCXl1xgfJP2H9id13sha</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Scaglione, Steve</creator><creator>Adams, William</creator><creator>Caines, Allyce</creator><creator>Devlin, Pauline</creator><creator>Mittal, Sahil</creator><creator>Singal, Amit G.</creator><creator>Parikh, Neehar D.</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0478-1089</orcidid></search><sort><creationdate>20200601</creationdate><title>Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma</title><author>Scaglione, Steve ; Adams, William ; Caines, Allyce ; Devlin, Pauline ; Mittal, Sahil ; Singal, Amit G. ; Parikh, Neehar D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-248747ccf59b916660e1dee3b31e24224623035433f44aaaaad9e64ed49cedb73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Ablation (Surgery)</topic><topic>Biochemistry</topic><topic>Carcinoma, Hepatocellular - economics</topic><topic>Carcinoma, Hepatocellular - epidemiology</topic><topic>Carcinoma, Hepatocellular - ethnology</topic><topic>Carcinoma, Hepatocellular - therapy</topic><topic>Care and treatment</topic><topic>Cohort Studies</topic><topic>Cultural differences</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Healthcare Disparities - ethnology</topic><topic>Hepatology</topic><topic>Hepatoma</topic><topic>Humans</topic><topic>Insurance</topic><topic>Insurance, Health</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver Neoplasms - economics</topic><topic>Liver Neoplasms - epidemiology</topic><topic>Liver Neoplasms - ethnology</topic><topic>Liver Neoplasms - therapy</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Property and casualty insurance industry</topic><topic>Race</topic><topic>Racial Groups</topic><topic>Retrospective Studies</topic><topic>Transplant Surgery</topic><topic>Transplantation</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scaglione, Steve</creatorcontrib><creatorcontrib>Adams, William</creatorcontrib><creatorcontrib>Caines, Allyce</creatorcontrib><creatorcontrib>Devlin, Pauline</creatorcontrib><creatorcontrib>Mittal, Sahil</creatorcontrib><creatorcontrib>Singal, Amit G.</creatorcontrib><creatorcontrib>Parikh, Neehar D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scaglione, Steve</au><au>Adams, William</au><au>Caines, Allyce</au><au>Devlin, Pauline</au><au>Mittal, Sahil</au><au>Singal, Amit G.</au><au>Parikh, Neehar D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>65</volume><issue>6</issue><spage>1669</spage><epage>1678</epage><pages>1669-1678</pages><issn>0163-2116</issn><issn>1573-2568</issn><eissn>1573-2568</eissn><abstract>Background
Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status.
Aims
Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA.
Study
We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups.
Results
Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival.
Conclusions
Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31643036</pmid><doi>10.1007/s10620-019-05890-2</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-0478-1089</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2020-06, Vol.65 (6), p.1669-1678 |
| issn | 0163-2116 1573-2568 1573-2568 |
| language | eng |
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| subjects | Ablation (Surgery) Biochemistry Carcinoma, Hepatocellular - economics Carcinoma, Hepatocellular - epidemiology Carcinoma, Hepatocellular - ethnology Carcinoma, Hepatocellular - therapy Care and treatment Cohort Studies Cultural differences Ethnicity Female Gastroenterology Healthcare Disparities - ethnology Hepatology Hepatoma Humans Insurance Insurance, Health Liver Liver cancer Liver Neoplasms - economics Liver Neoplasms - epidemiology Liver Neoplasms - ethnology Liver Neoplasms - therapy Male Medical prognosis Medicine Medicine & Public Health Middle Aged Oncology Original Article Patient outcomes Patients Prognosis Property and casualty insurance industry Race Racial Groups Retrospective Studies Transplant Surgery Transplantation United States - epidemiology |
| title | Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma |
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