ABSTRACT Background Hepatocellular carcinoma (HCC) survival in the United States varies sharply by neighborhood disadvantage. Aim To determine whether residence in persistently impoverished or low‐SES census tracts is independently associated with lower all‐cause and HCC‐specific survival. Methods We identified 51,323 adults with HCC using a population‐based retrospective cohort from the Surveillance, Epidemiology, and End Results Research Plus Specialized Database (2006–2020). Two census tract‐level socioeconomic exposures were defined: persistent poverty (≥ 20% living below the poverty line for approximately 30 years) and low SES (Yost Index first quintile). Overlap Propensity Score Weighting, combined with marginal structural models, estimated the 1‐, 5‐, 10‐, and 15‐year risks of all‐cause and HCC‐specific mortality. Results The median follow‐up was 16 months, 6058 (11.8%) lived in persistently impoverished tracts, and 9863 (19.5%) lived in low‐SES tracts. After weighting, residents of persistently impoverished areas had a 1‐year all‐cause mortality risk of 46.0% vs. 40.3% (RD, 5.6%; 95% CI, 4.4% to 6.9%; RR, 1.14; 95% CI, 1.11 to 1.17) and an HCC‐specific mortality risk of 33.3% vs. 28.6% (RD, 4.8%; 95% CI, 3.2% to 6.3%; RR, 1.17; 95% CI, 1.11 to 1.22). Living in low‐SES tracts raised 1‐year all‐cause mortality risk to 32.5% vs. 30.1% (RD, 4.8%; 95% CI, 3.6% to 6.0%; RR, 1.12; 95% CI, 1.09 to 1.15) and HCC‐specific mortality risk to 32.5% vs. 30.1% (RD, 2.5%; 95% CI, 1.4% to 3.5%; RR, 1.08; 95% CI, 1.05 to 1.12). Conclusions Both persistent neighborhood poverty and contemporary low SES independently contribute to significant increases in mortality risk after HCC diagnosis.
Elsaid et al. (Sun,) studied this question.