Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007

Sandy L. Kwong, Susan L Stewart, Christopher A. Aoki, Moon S Chen

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival. Methods: To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry. Results: Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95% confidence interval (95% CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95% CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95% CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95% CI, 1.03-1.48). Conclusions: Our hypothesis that survival outcomes would differ by ethnicity was verified. Impact: Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.

Original languageEnglish (US)
Pages (from-to)2747-2757
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume19
Issue number11
DOIs
StatePublished - Nov 2010

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Hepatocellular Carcinoma
Social Class
Confidence Intervals
Asian Americans
Survival
Ethnic Groups
Hepatitis B
Liver Transplantation
Population
Registries
Neoplasms
Therapeutics
Demography
Mortality
Health
Research

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007. / Kwong, Sandy L.; Stewart, Susan L; Aoki, Christopher A.; Chen, Moon S.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 19, No. 11, 11.2010, p. 2747-2757.

Research output: Contribution to journalArticle

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abstract = "Background: Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival. Methods: To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry. Results: Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95{\%} confidence interval (95{\%} CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95{\%} CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3{\%} receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95{\%} CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95{\%} CI, 1.03-1.48). Conclusions: Our hypothesis that survival outcomes would differ by ethnicity was verified. Impact: Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.",
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AB - Background: Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival. Methods: To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry. Results: Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95% confidence interval (95% CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95% CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95% CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95% CI, 1.03-1.48). Conclusions: Our hypothesis that survival outcomes would differ by ethnicity was verified. Impact: Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.

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