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Showing content from https://pubmed.ncbi.nlm.nih.gov/20143441/ below:

Racial and insurance disparities in the receipt of transplant among patients with hepatocellular carcinoma

. 2010 Apr 1;116(7):1801-9. doi: 10.1002/cncr.24936. Racial and insurance disparities in the receipt of transplant among patients with hepatocellular carcinoma

Affiliations

Affiliation

¹ Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA.

PMID: 20143441
PMCID: PMC3664455
DOI: 10.1002/cncr.24936

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Racial and insurance disparities in the receipt of transplant among patients with hepatocellular carcinoma

Jeanette C Yu et al. Cancer. 2010.

. 2010 Apr 1;116(7):1801-9. doi: 10.1002/cncr.24936. Affiliation

¹ Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA.

PMID: 20143441
PMCID: PMC3664455
DOI: 10.1002/cncr.24936

Item in Clipboard

Abstract

Background: : Patients with hepatocellular carcinoma (HCC) have a poor prognosis if their tumors are not diagnosed early. The authors investigated factors associated with the receipt of liver transplant among patients with HCC and evaluated the effects of these differences on survival.

Methods: : The authors reviewed records from consecutive patients diagnosed with HCC at Columbia University Medical Center from January 1, 2002 to September 1, 2008. We compared patient clinical and demographic characteristics, developed a multivariable logistic regression model of predictors of transplant, and used a Cox model to analyze predictors of mortality.

Results: : Of 462 HCC patients, 175 (38%) received a transplant. Black patients were much less likely than whites to receive a transplant (odds ratio [OR], 0.03; 95% confidence interval [CI], 0.0-0.37). Hispanics and Asians were also less likely to undergo transplantation, but the differences were not statistically significant. Patients with private insurance were more likely to receive a transplant than those with Medicaid (odds ratio [OR], 22.07; 95% confidence interval [CI], 2.67-182.34). Black and Hispanic patients, and Medicaid recipients, presented with more advanced disease than whites and privately insured patients, and had poorer survival. In a Cox model, those who did not receive a transplant were 3 times as likely as transplant recipients to die, but race and insurance were not independently predictive of mortality.

Conclusions: : Race and insurance status were strongly associated with receipt of transplantation and with more advanced disease at diagnosis, but transplantation was the most important determinant of survival. Improved access to care for nonwhite and Medicaid patients may allow more patients to benefit from transplant. Cancer 2010. (c) 2010 American Cancer Society.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Supported by NIH/Columbia CTSA K12 Mentored Career Development Award (K12 RR024157-03), NIH CALME pilot grant (P30 AG135294-10), a Pardes Scholarship, and the Steven J. Levinson Medical Research Foundation (to ABS).

Figures
Figure 1

Kaplan-Meier survival curves are shown…

Figure 1

Kaplan-Meier survival curves are shown for transplant versus nontransplant for hepatocellular carcinoma. Log-rank,…

Figure 1

Kaplan-Meier survival curves are shown for transplant versus nontransplant for hepatocellular carcinoma. Log-rank, P < .0001.

Figure 2

Depicted are Kaplan-Meier survival curves…

Figure 2

Depicted are Kaplan-Meier survival curves by race and/or ethnicity. Log-rank, P = .0008.

Figure 2

Depicted are Kaplan-Meier survival curves by race and/or ethnicity. Log-rank, P = .0008.

Figure 3

Kaplan-Meier survival curves are shown…

Figure 3

Kaplan-Meier survival curves are shown for insurance status. Log-rank, P <.0001.>

Figure 3

Kaplan-Meier survival curves are shown for insurance status. Log-rank, P<.0001.