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

Backgroundand Aims: 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 healthcare system. Approach and Results: We conducted a retrospective cohort study of 3,441 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 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. Conclusions: 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.