The effect of social determinants of health on utilization of surgical treatment for hepatocellular carcinoma patients

Published:October 11, 2022DOI:


      • Neighborhood SDOH domains related to built environment, education, economics, social context affect utilization of HCC surgery.
      • Black patients had significantly lower odds of surgery vs Whites but not after adjustments for SDOH.
      • Any patients with insurances other than private insurance had lower odds of surgery for HCC.



      A paucity of data exists on how social determinants of health (SDOH) influence treatment for Hepatocellular carcinoma (HCC). We investigated associations between SDOH (healthcare access, education, social/community context, economic stability, and built/neighborhood environment) and receipt of surgery.


      The Pennsylvania Liver Cancer Registry was linked with neighborhood SDOH from the American Community Survey. Multilevel logistic regression models with patient and neighborhood SDOH variables were developed.


      Of 9423 HCC patients, 2393 were stage I. Only 36.3% of stage I patients received surgery. Black patients had significantly lower odds of surgery vs Whites (OR = 0.73; p < 0.01), but not after adjustments for SDOH. All 5 SDOH domains were associated with odds of surgery overall; 2 domains were associated in Stage I patients, social context (e.g., racial concentration, p = 0.03) and insurance access (p < 0.01).


      SDOH impact utilization of surgery for HCC. Findings can guide healthcare professionals to create programs for populations at risk for poor liver cancer outcomes.
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