Disparities in Native American Patients With Hepatocellular Carcinoma: An NCDB Analysis

PURPOSE Hepatocellular carcinoma (HCC) is on the rise in the United States and worldwide. Native Americans have been found to have higher rates of mortality from HCC compared to the rest of the population. The purpose of this study is to identify disparities that affect Native Americans with HCC. METHODS This retrospective cohort analysis utilizing the National Cancer Database identified 275801 patients diagnosed with HCC (ICD-8170-3) between 2004 and 2020. Descriptive statistics for all HCC patients were collected. Those who identified as American Indian, Aleutian, or Eskimo were grouped as Native American, and all other races (AOR) were grouped as other. Sex, median household income, and facility type were compared between Native American patients and patients of AOR using Pearson Chi-Square test. Age at diagnosis and great circle distance between Native Americans and AOR were evaluated using independent t-test. All variables were evaluated for a significance of P < 0.05. RESULTS In total, 2078 cases were in Native Americans (0.8%) with 205246 cases in white patients (74.4%) and 40772 cases in black patients (14.8%). Native Americans had a higher proportion of female patients compared to AOR (30.8% vs. 25.8%, P < 0.05). Native Americans were less likely to be treated at an academic facility compared to AOR (42.2% vs. 51.0%, P < 0.05). Native Americans were also more likely to be lower income when compared to AOR (51.0% vs 39.6%). The average age at diagnosis was significantly lower in Native Americans compared with AOR (61.6 years vs. 64.1 years, P < 0.05). Great circle distance was significantly greater for Native Americans compared with AOR (90.8 miles vs. 40.6 miles, P < 0.05). CONCLUSION Having identified significant disparities in Native Americans with HCC, we hope this can provide a starting point in studying the effects these disparities may have on treatment outcomes and overall survival.