Highlights
- •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.
Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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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Article info
Publication history
Published online: October 11, 2022
Accepted:
October 7,
2022
Received in revised form:
September 17,
2022
Received:
June 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
