Racial, gender and socioeconomic disparities in survival outcomes of hepatocellular carcinoma.

526 Background: Hepatocellular carcinoma (HCC) is the sixth most commonly occurring cancer worldwide, with mortality rates increasing globally, particularly in the Western world. The 5‐year survival rate of persons with HCC is less than 20%. It is, therefore, essential to investigate the extent to which social determinants of health influence survival outcomes. In this study, we explored the effect of gender, race/ethnicity and socioeconomic factors on survival outcomes among patients with HCC in the United States. Methods: We extracted data on patients with a histologic diagnosis of hepatocellular carcinoma from the Surveillance, Epidemiology and End Result (SEER) Registry from 2000-2021. The primary outcome of interest was the cause-specific survival of these patients. According to the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) system, the histological code of HCC is 8170/3. We excluded patients of missing or unknown race, income, location, and patients outside the years of study. Cox proportional hazard regression (SPSS) was utilized to determine the association between patients' race/ethnicity, gender, annual median income, location and cause-specific survival. Results: 80,445 met the criteria and were included in our study. Gender proved to be a predictor of survival; compared to females, males had worse outcomes, with males HR 1.040 (95% CI; 1.020-1.060, p = <0.001). Race was a predictor of survival outcomes. Using American Indian/Alaska Native as our reference, Asian/Pacific Islander HR 0.847 (95% CI; 0.790-0.90, p = <0.001), Black HR 1.019 (95% CI; 0.950-1.093, p = 0.603), White HR 0.955 (95% CI; 0.893-1.023, p = 0.186). We also analyzed the effects of socioeconomic factors on survival. Patients with higher annual median income had better outcomes. >$120000 HR 0.817 (95% CI; 0.783-0.851, p = <0.001) while patients with lower annual median income had worse outcomes < $40000 HR 1.217 (95% CI; 1.134-1.305, p < 0.001). The effect of location on survival was not significant. Compared to non-metropolitan areas, metropolitan areas HR 0.988 (95% CI; 0.971–1.004, p = 0.138). Conclusions: Race/ethnicity, income and gender disparities all played a significant role in cause-specific survival in patients with HCC, with improved survival observed in females, Asians and patients with higher annual median income. More efforts are needed to bridge these survival disparities.