The impact of socioeconomic status with overall survival in hepatocellular carcinoma: a systematic review and meta-analysis

<h3>Background</h3> Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the second leading cause of cancer-related mortality worldwide. Patients are typically diagnosed at an advanced stage, with a poor prognosis. Despite recent therapeutic advances in HCC, there are concerns about the accessibility of these treatments for patients of lower socioeconomic status (SES), which may lead to poorer outcomes and exacerbate health inequity. <h3>Methods</h3> We searched MEDLINE and Embase from inception to 26 April 2024 to identify cohort studies comparing SES indicators and HCC outcomes. We computed hazard ratios (HRs) with accompanying 95% confidence intervals (CIs) for each study and pooled the results using a random-effects meta-analysis. Quality assessment was carried out using the Newcastle–Ottawa Quality Assessment Scale. <h3>Results</h3> In this meta-analysis of 15 studies involving 199 404 patients, we analysed the impact of SES on overall survival in patients with HCC. Lower income (HR 1.10, 95% CI 1.02-1.18, <i>P</i> < 0.01) and lower insurance coverage (HR 1.22, 95% CI 1.12-1.32, <i>P</i> = 0.01) had a negative impact on overall survival from HCC, but we were unable to stratify by stage. Absent or reduced insurance status had a negative impact on overall survival from HCC, regardless of the stage of HCC (early-stage HR 1.18, 95% CI 1.03-1.36 versus all-stage HR 1.25, 95% CI 1.13-1.38). <h3>Conclusion</h3> Lower income and insurance coverage negatively impacted overall survival from HCC. Absent or reduced insurance status negatively impacted overall survival from HCC, regardless of the stage of HCC. Further studies from low- to middle-income and Asian countries are needed. There is an urgent need to develop policies to reduce the survival gap between patients with HCC of differing SES status.