Detailed Racial/Ethnic Disparities in Hepatocellular Carcinoma Risk With an Electronic Health Record–Based Cohort

BACKGROUND & AIMS: We assessed sex-specific disparities in hepatocellular carcinoma (HCC) risk according to detailed race/ethnicity with a multi-institutional, electronic health record (EHR)-based cohort. METHODS: We linked an EHR-based cohort of adult patients at Sutter Health, Kaiser Permanente Hawai'i, and San Francisco Health Network from 2000 to 2016 or 2017 to population-based cancer registry data for incident HCC. Race and ethnicity data were operationalized into 17 detailed categories. We used sex-stratified Cox regression to assess racial/ethnic disparities in HCC. A secondary analysis explored cirrhosis-stratified disparities, with cirrhosis being defined as the occurrence of one or more International Classification of Diseases, Ninth or Tenth Revision codes indicating cirrhosis or complications thereof. RESULTS: Among 4,248,553 patients, 2916 developed HCC. Vietnamese American females (hazard ratio, 5.5; 95% confidence interval, 2.3-13.2) and males (hazard ratio, 5.4; 95% confidence interval, 3.1-9.6) had the highest HCC risk compared with their non-Hispanic White counterparts. For both sexes, those who were Native Hawaiian, Chinese or Korean American, had another single Asian ethnicity or multiple Asian ethnicities, or were Black or Hispanic had greater HCC risk than non-Hispanic White patients. Filipino and Japanese American females and males and those who were American Indian or Alaska Native or had multiple races or ethnicities also had greater risk. Exploratory analyses showed that, for both sexes, racial/ethnic disparities were mitigated within the context of EHR-documented cirrhosis but not without. CONCLUSIONS: Our innovative use of EHR data on race and ethnicity advances disparities research methodology, yielding findings on HCC disparities not apparent with broad categories. More persistent racial/ethnic disparities among those without EHR-documented cirrhosis suggest racial and ethnic differences in coordinated hepatitis screening and treatment, cirrhosis recognition and documentation, or health care delivery and thus inform efforts to reduce HCC disparities.