Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Study

Background While hepatocellular carcinoma (HCC) is ideally diagnosed outpatient by screening at-risk patients, many are diagnosed in Emergency Departments (ED) due to undiagnosed liver disease and/or limited access-to-healthcare. This study aims to identify sociodemographic/clinical factors associated with being diagnosed with HCC in the ED to identify patients who may benefit from improved access-to-care. Methods HCC patients diagnosed between 2012 and 2014 in the ED or an outpatient setting [Primary Care Physician (PCP) or hepatologist] were identified from the US Safety-Net Collaborative database and underwent retrospective chart-review. Multivariable regression identified predictors for an ED diagnosis. Results Among 1620 patients, median age was 60, 68% were diagnosed outpatient, and 32% were diagnosed in the ED. ED patients were more likely male, Black/Hispanic, uninsured, and presented with more decompensated liver disease, aggressive features, and advanced clinical stage. On multivariable regression, controlling for age, gender, race/ethnicity, poverty, insurance, and PCP/navigator access, predictors for ED diagnosis were male (odds ratio [OR] 1.6, 95% confidence interval [CI]: 1.1-2.2,p = 0.010), black (OR 1.7, 95% CI: 1.2-2.3,p = 0.002), Hispanic (OR 1.6, 95% CI: 1.1-2.6,p = 0.029), > 25% below poverty line (OR 1.4, 95% CI: 1.1-1.9,p = 0.019), uninsured (OR 3.9, 95% CI: 2.4-6.1,p < 0.001), and lack of PCP (OR 2.3, 95% CI: 1.5-3.6,p < 0.001) or navigator (OR 1.8, 95% CI: 1.3-2.5,p = 0.001). Conclusions The sociodemographic/clinical profile of patients diagnosed with HCC in EDs differs significantly from those diagnosed outpatient. ED patients were more likely racial/ethnic minorities, uninsured, and had limited access to healthcare. This study highlights the importance of improved access-to-care in already vulnerable populations.

Automated summary

The study identified demographic and clinical factors associated with HCC diagnosis in Emergency Departments (ED), showing that patients diagnosed in ED were more likely to be male, racial minorities, uninsured, and have limited access to healthcare. Improving access-to-care is crucial for vulnerable populations diagnosed with HCC in ED.