Socioeconomic Inequalities in Receipt of Curative‐Intent Treatment and Survival After Surveillance‐Detected Hepatocellular Carcinoma: A Nationwide Cohort Study

BACKGROUND: Surveillance for hepatocellular carcinoma (HCC) aims to enable early diagnosis and receipt of curative-intent treatment; however, socioeconomic status (SES) influences both participation in surveillance and subsequent outcomes. Whether SES-related disparities persist among individuals diagnosed through surveillance remains unclear. AIMS: To examine sociodemographic factors associated with receipt of curative-intent treatment and mortality among individuals with surveillance-detected HCC. METHODS: We conducted a nationwide cohort study including adults with cirrhosis and surveillance-detected HCC diagnosed in Sweden between January 1, 2012, and December 31, 2022. Sociodemographic data and outcomes were obtained through linkage to national registers. The primary outcome was receipt of curative-intent treatment, analysed using multivariable logistic regression. Post-treatment mortality was assessed using multivariable Cox regression. RESULTS: Among 1,514 individuals with surveillance-detected HCC, 845 (56%) were diagnosed at an early stage, and 974 (64%) received curative-intent treatment. After adjustment for tumour characteristics, liver disease aetiology and severity, performance status, comorbidities, and calendar period, low SES was independently associated with a lower likelihood of receiving curative-intent treatment (adjusted odds ratio 0.42, 95% CI 0.26-0.66, low vs. high SES). Among those treated with curative intent, low SES was also associated with higher mortality (adjusted hazard ratio 1.50, 95% CI 1.10-2.00). CONCLUSIONS: Socioeconomic inequalities in the receipt of curative-intent treatment and survival persist even among individuals with surveillance-detected HCC within a universal healthcare system. These findings indicate that surveillance alone is insufficient to ensure equitable outcomes and underscore the need for regionally tailored, people-centred strategies that address social vulnerability across the HCC care continuum.