Comparing barriers to early stage diagnosis of hepatocellular carcinoma between safety net hospitals and academic medical centers: An analysis from the United States Safety-Net Collaborative

Sophia L Stylianos; Caroline R Goel; Rachel M Lee; Adam Yopp; Joshua Kronenfeld; Neha Goel; Jashodeep Datta; Ann Lee; Eric Silberfein; Maria C Russell; and other members of the United States Safety‐Net Collaborative

doi:10.1002/jso.27787

Comparing barriers to early stage diagnosis of hepatocellular carcinoma between safety net hospitals and academic medical centers: An analysis from the United States Safety-Net Collaborative

J Surg Oncol. 2024 Aug 1. doi: 10.1002/jso.27787. Online ahead of print.

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
² Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical School, Dallas, Texas, USA.
³ Division of Surgical Oncology, Department of Surgery, University of Miami Medical School, Miami, Florida, USA.
⁴ Division of Surgical Oncology, Department of Surgery, New York University Medical School, New York, New York, USA.
⁵ Division of Surgical Oncology, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.

PMID: 39087490
DOI: 10.1002/jso.27787

Abstract

Background and objectives: Early detection of hepatocellular carcinoma (HCC) is associated with improved survival. However, a greater proportion of patients treated at safety net hospitals (SNHs) present with late-stage disease compared to those at academic medical centers (AMCs). This study aims to identify barriers to diagnosis of HCC, highlighting differences between SNHs and AMCs.

Methods: The US Safety Net Collaborative-HCC database was queried. Patients were stratified by facility of diagnosis (SNH or AMC). Patient demographics and HCC screening rates were examined. The primary outcome was stage at diagnosis (AJCC I/II-"early"; AJCC III/IV-"late").

Results: 1290 patients were included; 50.2% diagnosed at SNHs and 49.8% at AMCs. At SNHs, 44.4% of patients were diagnosed late, compared to 27.6% at AMCs. On multivariable regression, Black race was associated with late diagnosis in both facilities (SNH: odds ratio 1.96, p = 0.03; AMC: 2.27, <0.01). Screening was associated with decreased odds of late diagnosis (SNH: 0.46, p = 0.04; AMC: 0.37, p < 0.01).

Conclusions: Black race was associated with late diagnosis of HCC, while screening was associated with early diagnosis across institutional types. These results suggest socially constructed racial bias in screening and diagnosis of HCC. Screening efforts targeting SNH patients and Black patients at all facilities are essential to reduce disparities.

Keywords: HCC; racial bias; screening; social determinants of health.