| Abstract: | Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in the United States (US). Racial-ethnic minority groups are at a greater risk of treatment underutilization and delay, along with worse outcomes. Prior published literature in other cancers like lung, colorectal, prostate indicates that social determinants of health (SDOH) like lower neighborhood SES are associated with worse survival. However, the interplay between race, ethnicity, and SDOH has not been well explored among HCC patients. Therefore, this dissertation aims to (1) characterize and quantify racial-ethnic disparities in treatment receipt among patients with HCC through a meta-analysis; (2) characterize the interaction of racial, ethnic, and neighborhood socioeconomic disparities in curative treatment use and overall survival in the US among a large population-based sample of patients with HCC (3) describe the prevalence and disparities in HCC treatment delay and evaluate the association between treatment delay and overall survival in a large population-based sample of patients with HCC in the US. Results from the first study indicate that Black and Hispanic patients had a lower pooled odds ratio (OR) for receipt of curative treatment when compared to White patients. Additionally, Black patients had lower pooled OR for receiving any HCC-specific treatment when compared to White patients. Results from the second study indicate that curative treatment was underutilized among HCC patients. Additionally, Black patients living in high poverty neighborhoods had lower odds of receiving curative treatment and worse survival when compared to white patients living in similar neighborhoods. Results from the third study indicate that Black patients and those living in high poverty neighborhoods had higher odds of receiving delayed treatment. Subsequently, delayed treatment was associated with worse overall survival. Neighborhood poverty level may be a mediating factor adding to persisting racial-ethnic disparities in treatment receipt. Additionally, racial-ethnic disparities persist among treatment delays. Future studies should aim at understanding the role of various SDOH in the HCC care continuum to be able to design interventions that reduce these disparities and achieve equitable outcomes among traditionally marginalized groups in the US. The electronic version of this dissertation is accessible from https://hdl.handle.net/1969.1/197227 |
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