Social Drivers Linked to Hepatocellular Carcinoma Stage and Survival in US Integrated Care System
Key Takeaways
- In a cohort of 3441 adults with hepatocellular carcinoma (HCC) within Kaiser Permanente Northern California, race and ethnicity and neighborhood deprivation were associated with differences in stage at diagnosis and survival.
- Asian and Pacific Islander patients had lower odds of advanced-stage HCC and better 5-year survival compared with White patients.
- Residence in more socioeconomically deprived neighborhoods was associated with worse 5-year survival, despite similar treatment patterns across groups.
Racial and ethnic background and neighborhood-level socioeconomic deprivation were associated with differences in stage at diagnosis and survival among patients with HCC in a large, integrated US health care system, according to a retrospective cohort study conducted within Kaiser Permanente Northern California.
Study Findings
Investigators evaluated 3441 adults diagnosed with HCC between 2006 and 2019. The median age was 65 years, and 75.0% were male. The cohort included 42.6% White, 8.4% Black, 21.9% Hispanic or Latinx, and 24.6% Asian or Pacific Islander patients.
Advanced HCC, defined as Barcelona Clinic Liver Cancer stage C, was more common among Black patients (32.6%). In multivariable analyses, Asian and Pacific Islander patients had lower odds of presenting with advanced-stage disease compared with White patients (adjusted odds ratio, 0.62; 95% CI, 0.48-0.81).
Treatment patterns, including receipt of curative or any treatment, did not significantly differ by race and ethnicity, insurance type, or neighborhood deprivation index. However, survival differences persisted. Asian and Pacific Islander patients experienced better 5-year survival compared with White patients (adjusted hazard ratio, 0.74; 95% CI, 0.64-0.87).
Neighborhood deprivation was independently associated with outcomes. Patients residing in more socioeconomically deprived neighborhoods had worse 5-year survival compared with those in less deprived areas (adjusted hazard ratio, 1.20; 95% CI, 1.01-1.41).
Clinical and Policy Implications
HCC disproportionately affects racial and ethnic minority and socioeconomically disadvantaged populations. Although this study was conducted within an integrated health care system with uniform access to care, disparities in stage at diagnosis and long-term survival were still observed.
The lack of differences in treatment receipts suggests that upstream factors—such as earlier detection, screening uptake, comorbidity burden, or structural barriers to timely evaluation—may drive outcome disparities. The association between neighborhood deprivation and survival highlights the importance of addressing social determinants of health even within systems designed to reduce access barriers.
For managed care stakeholders, these findings underscore the need for targeted outreach, enhanced surveillance programs, and population health strategies aimed at earlier HCC detection in high-risk communities. Incorporating neighborhood-level risk indicators into care management models may help identify patients at elevated risk of late-stage diagnosis and poorer survival.
Conclusion
Within a large integrated US health system, race/ethnicity and neighborhood deprivation were associated with differences in HCC stage at diagnosis and 5-year survival. While treatment patterns were similar, persistent disparities suggest that structural and social factors influence outcomes. Efforts to improve early detection and reduce socioeconomic barriers may help narrow these inequities in HCC care.
References
Yilma M, Houhong Xu R, Tucker LS, et al. Social drivers of differences in hepatocellular carcinoma (HCC) stage of diagnosis, treatment, and survival in a large, integrated health care system. Liver Transpl. 2026. Published online ahead of print. doi:10.1097/LVT.0000000000000809.
