The Impact of Socioeconomic Status on Mortality in Patients with Hepatocellular Carcinoma: A Korean National Cohort Study
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Background/Aims: We studied the impact of socioeconomic status (SES) on mortality in hepatocellular carcinoma patients and analyzed the effect of SES on initial treatment allocation. Methods: A cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea. A total of 3,032 hepatocellular carcinoma patients who were newly diagnosed between January 2003 and December 2013 were included. Income level was categorized as Medical Aid and ≤30th, 31st–70th, or >70th percentile as an SES indicator. Results: The proportion of Medical Aid was 4.3%. The highest risks of all-cause mortality associated with Medical Aid were evident in the transcatheter arterial chemoembolization group (fully adjusted hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04) but not in the curative treatment group. An association between the lower-income percentile and higher liver cancer-specific mortality was also observed, except in the curative treatment group. The association between income percentile and all-cause mortality was nonlinear, with a stronger association in the lower-income percentiles than in the higher income percentiles (p-value for nonlinear spline terms <0.05). Conclusions: Patients in the lower SES group, especially patients not eligible for curative treatment, had an increased risk of mortality. In addition, the association between SES and the risk for mortality was stronger in the lower-income percentile than in the moderate to higher income percentiles.
Abstract
Background/Aims: We studied the impact of socioeconomic status (SES) on mortality in hepatocellular carcinoma patients and analyzed the effect of SES on initial treatment allocation. Methods: A cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea. A total of 3,032 hepatocellular carcinoma patients who were newly diagnosed between January 2003 and December 2013 were included. Income level was categorized as Medical Aid and ≤30th, 31st–70th, or >70th percentile as an SES indicator. Results: The proportion of Medical Aid was 4.3%. The highest risks of all-cause mortality associated with Medical Aid were evident in the transcatheter arterial chemoembolization group (fully adjusted hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58), the other treatments group (fully adjusted HR, 2.86; 95% CI, 1.85 to 4.41), and the no treatment group (fully adjusted HR, 2.69; 95% CI, 1.79 to 4.04) but not in the curative treatment group. An association between the lower-income percentile and higher liver cancer-specific mortality was also observed, except in the curative treatment group. The association between income percentile and all-cause mortality was nonlinear, with a stronger association in the lower-income percentiles than in the higher income percentiles (p-value for nonlinear spline terms <0.05). Conclusions: Patients in the lower SES group, especially patients not eligible for curative treatment, had an increased risk of mortality. In addition, the association between SES and the risk for mortality was stronger in the lower-income percentile than in the moderate to higher income percentiles.
참고문헌 (29)
- Wang S, "Improved survival of patients with hepatocellular carcinoma and disparities by age, race, and socioeconomic status by decade, 1983-2012", Oncotarget, 7, pp.59820~59833 (2016)
- Abdel-Rahman O, "Cigarette smoking as a risk factor for the development of and mortality from hepatocellular carcinoma : an updated systematic review of 81 epidemiological studies", J Evid Based Med, 10, pp.245~254 (2017)
- Massarweh NN, "Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma", Cancer Control, 24, pp.1073274817729245~ (2017)
- El-Serag HB, "Hepatocellular carcinoma", N Engl J Med, 365, pp.1118~1127 (2011)
- Joshi S, "Socio-economic status and the risk of liver cancer mortality : a prospective study in Korean men", Public Health, 122, pp.1144~1151 (2008)
- Artinyan A, "Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States", Cancer, 116, pp.1367~1377 (2010)
- Jembere N, "Influence of socioeconomic status on survival of hepatocellular carcinoma in the Ontario population : a population-based study, 1990-2009", PLoS One, 7, pp.e40917~ (2012)
- Clark PJ, "Remoteness, race and social disadvantage : disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia", Liver Int, 35, pp.2584~2594 (2015)
- Sarpel U, "Disentangling the effects of race and socioeconomic factors on liver transplantation rates for hepatocellular carcinoma", Clin Transplant, 30, pp.714~721 (2016)
- Sellers CM, "The impact of socioeconomic status on outcomes in hepatocellular carcinoma : inferences from primary insurance", Cancer Med, 8, pp.5948~5958 (2019)
- Abdel-Rahman O, "Treatment choices and outcomes of nonmetastatic hepatocellular carcinoma patients in relationship to neighborhood socioeconomic status : a population-based study", Int J Clin Oncol, 25, pp.861~866 (2020)
- Zak Y, "Predictors of surgical intervention for hepatocellular carcinoma : race, socioeconomic status, and hospital type", Arch Surg, 146, pp.778~784 (2011)
- Zhang Y, "Association between neutrophil-lymphocyte ratio, socioeconomic status, and ethnic minority with treatment outcome in hepatocellular carcinoma", Hepatol Int, 13, pp.609~617 (2019)
- Chun CB, "Republic of Korea : health system review", Health Syst Transit, 11, pp.1~184 (2009)
- Lee J, "Cohort profile : the National Health Insurance Service-National Sample Cohort(NHIS-NSC), South Korea", Int J Epidemiol, 46, pp.e15~ (2017)
- Shin DW, "Korean National Health Insurance Database", JAMA Intern Med, 176, pp.138~ (2016)
- Llovet JM, "Prognosis of hepatocellular carcinoma : the BCLC staging classification", Semin Liver Dis, 19, pp.329~338 (1999)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Grant SR, "A brighter future? The impact of insurance and socioeconomic status on cancer outcomes in the USA : a review", Future Oncol, 12, pp.1507~1515 (2016)
- Zaydfudim V, "Health insurance status affects staging and influences treatment strategies in patients with hepatocellular carcinoma", Ann Surg Oncol, 17, pp.3104~3111 (2010)
- Wang J, "Medicaid and uninsured hepatocellular carcinoma patients have more advanced tumor stage and are less likely to receive treatment", J Clin Gastroenterol, 52, pp.437~443 (2018)
- Goudge J, "A review of experience concerning household ability to cope with the resource demands of ill health and health care utilization" (2000), EQUINET
- Mantovani LG, "Healthcare costs associated with hepatocellular carcinoma and the value of care", Hepatology, 58, pp.1213~1214 (2013)
- Thein HH, "Health care costs associated with hepatocellular carcinoma : a population-based study", Hepatology, 58, pp.1375~1384 (2013)
- Grant U, "Health and poverty linkages: perspectives of the chronically poor" (2005), Chronic Poverty Research Centre
- Lorgelly PK, "Survivorship burden for individuals, households and society : Estimates and methodology", J Cancer Policy, 15, pp.113~117 (2018)
- Schütte K, "Delayed diagnosis of HCC with chronic alcoholic liver disease", Liver Cancer, 1, pp.257~266 (2012)
- Bucci L, "Comparison between alcohol-and hepatitis C virus-related hepatocellular carcinoma : clinical presentation, treatment and outcome", Aliment Pharmacol Ther, 43, pp.385~399 (2016)
- Kwon S, "Thirty years of national health insurance in South Korea : lessons for achieving universal health care coverage", Health Policy Plan, 24, pp.63~71 (2009)