Social drivers of differences in hepatocellular carcinoma (HCC) stage of diagnosis, treatment, and survival in a large, integrated health care system

Hepatocellular carcinoma (HCC) disproportionately affects racial/ethnic minorities and socioeconomically disadvantaged populations. We assessed how race/ethnicity, insurance type, and neighborhood deprivation relate to HCC stage at diagnosis, treatment receipt, and survival in an integrated health care system. We conducted a retrospective cohort study of 3441 adults diagnosed with HCC between 2006 and 2019 within Kaiser Permanente Northern California. Multivariable Cox regression models evaluated associations between race/ethnicity, insurance type, neighborhood deprivation index (NDI), and key outcomes: advanced-stage HCC (Barcelona Clinic Liver Cancer stage C), receipt of curative or any treatment, and 5-year survival. Among patients with HCC (median age 65 y; 75.0% male), 42.6% were White, 8.4% Black, 21.9% Hispanic/Latinx, and 24.6% Asian/Pacific Islander (API). Advanced-stage HCC was more common among Black (32.6%) and although HCC treated patterns did not differ by race/ethnicity, insurance type, or neighborhood deprivation index, API patients had lower odds of presenting with advanced-stage HCC (adjusted odds ratio, 0.62, 95% CI 0.48-0.81) and had better 5-year survival (adjusted hazard ratio 0.74; 95% CI 0.64-0.87) compared with White patients. Residence in a more socioeconomically deprived neighborhood was associated with worse 5-year survival (adjusted hazard ratio, 1.20; 95% CI, 1.01-1.41) relative to residence in less deprived areas. These findings highlight persistent inequities in HCC stage at diagnosis and survival, with API patients experiencing more favorable outcomes and individuals from socioeconomically deprived neighborhoods facing worse long-term survival. Efforts to reduce structural barriers and improve early detection are needed to narrow these disparities.