Census tract-level persistent poverty and liver cancer survival: a population-based study

Abstract Background: Liver cancer incidence and mortality are rising in the United States, with marked racial and socioeconomic disparities. Persistent poverty, defined as communities where ≥ 20% of residents have lived below the federal poverty line for ≥ 30 years, is an important but understudied contextual determinant of cancer survival. This study examined the association between census tract-level persistent poverty and liver cancer survival. Methods: We analyzed 73,695 adult, population-based liver cancer patients aged ≥ 20 years, diagnosed 2006-2019 in the SEER 17 Registries. Persistent poverty status was assigned by residence at diagnosis. Cancer-specific and overall survival were estimated using Kaplan-Meier and Cox models, adjusting for demographic factors, stage at diagnosis, and initial treatment. We evaluated effect modification by age, sex, race/ethnicity, rurality, and stage at diagnosis. Results: Over 168,715 person-years, 56,373 deaths occurred; 81% were cancer-specific. Eleven percent of patients lived in persistent poverty tracts. Median cancer-specific survival was 16 months in persistent poverty tracts versus 22 months in non-persistent tracts (p0.001). In fully adjusted models, persistent poverty was associated with 9% higher cancer-specific mortality (HR=1.09; 95% CI, 1.06-1.12) and 11% higher all-cause mortality (HR=1.11; 95% CI, 1.09-1.14). Associations were strongest in patients 65 and with localized disease, with no significant differences by race/ethnicity, sex, or rurality. Conclusions: Living in a persistent poverty census tract is associated with worse liver cancer survival, particularly among younger patients and those with localized disease. Impact: Interventions and policies targeting economically disadvantaged communities may be important for reducing liver cancer survival disparities.