Regional, racial/ethnic, and socioeconomic disparities and treatment outcomes in patients with hepatocellular carcinoma (HCC) in the US.

Challenge

Administrative database studies of HCC disparities lacked clinical covariates, and single-center studies lacked generalizability, leaving a gap in real-world evidence on whether racial, ethnic, socioeconomic, and geographic disparities actually translate into differences in HCC treatment receipt and outcomes when clinical confounders are properly controlled.

Solution

The TARGET-HCC cohort was analyzed using multivariable logistic regression and Cox proportional hazard models with random intercepts for site to assess the association of race, ethnicity, insurance status, and geographic region with early tumor detection, curative intent therapy receipt, and overall survival.

Impact

Demonstrating that socioeconomic disparities in curative intent therapy receipt persist after clinical adjustment—while racial/ethnic disparities in this cohort did not reach significance—provides actionable, clinically adjusted equity evidence for sponsors designing trials with diverse enrollment requirements and health equity commitments.