Household Income, Geographical Location Affect Liver Cancer Mortality

Patients with liver cancer who live in a rural region and with a lower household income are more likely to present with later stage disease and have a greater mortality risk, according to a study, although the reason for the relationship was unclear.

“While our study could not specifically investigate the reasons for the worse liver cancer outcomes, we hypothesize that patients living in more rural regions and among lower income households likely experience healthcare disparities leading to sub-optimal access to high quality liver disease care, including timely receipt of liver cancer surveillance and access to liver disease specialists,” said Robert J. Wong, MD, MS, of the Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, in a press release.

Dr. Wong and his colleagues retrospectively reviewed Surveillance, Epidemiology, and End Results (SEER) liver cancer data per 100,000 persons from 2004 through 2017. The SEER staging system was used to determine tumor stage at diagnosis.

Over the study period, liver cancer incidence plateaued in most patients, except for American Indian/Alaska Native patients as well as those with the lowest household income.

Patients with liver cancer living in rural regions, compared to those living in large metropolitan areas where the population was greater than 1 million, were more likely to have advanced disease upon diagnosis (odds ratio [OR]=1.10; 95% confidence interval [CI], 1.00-1.20; P=0.04), and had a higher risk for mortality (hazard ratio [HR]=1.05; 95% CI, 1.01-1.08; P=0.02).

Patients with liver cancer who earned <$40,000 per year, compared to those in the highest income group (≥$70,000), were more likely to be diagnosed with later stage disease (OR=1.15; 95% CI, 1.01-1.32; P=0.03), and had higher mortality (HR=1.23; 95% C, 1.16-1.31; P<0.001).

“Our study highlights the need to focus on understanding the drivers of poor liver cancer outcomes among underserved and vulnerable populations, including those in rural geographic regions or among low income households, so that targeted quality improvement interventions can more specifically address the needs of these populations. We also hope that our findings will raise greater awareness of challenges and limited resources that contribute to sub-optimal liver disease care experienced by patients from low-income and rural households,” Dr. Wong said.

The results of the study were published in Cancer.