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Influence of Socioeconomic Status on Survival of Hepatocellular Carcinoma in the Ontario Population; A Population-Based Study, 1990–2009

Author

Listed:
  • Nathaniel Jembere
  • Michael A Campitelli
  • Morris Sherman
  • Jordan J Feld
  • Wendy Lou
  • Stuart Peacock
  • Eric Yoshida
  • Murray D Krahn
  • Craig Earle
  • Hla-Hla Thein

Abstract

Background: Research has shown that people from higher socioeconomic status (SES) have better hepatocellular carcinoma (HCC) survival outcomes, although no such research has been carried out in Canada. We aimed to assess if an association between SES and HCC survival existed in the Canadian context. Methodology/Prinicpal Findings: We conducted a population-based cohort study linking HCC cases identified in the Ontario Cancer Registry between 1990 and 2009 to administrative and hospital data. Logistic regression and chi-squared tests were used to evaluate associations between SES (income quintile) and covariates. The Kaplan-Meier method was used to estimate survival. Sequential analysis of the proportional-hazards models were used to determine the association between SES and HCC survival controlling for potential prognostic covariates. During the period 1990–2009, 5,481 cases of HCC were identified. A significant association was found between SES and curative treatment (p = 0.0003), but no association was found between SES and non-curative treatment (p = 0.064), palliative treatment (p = 0.680), or ultrasound screening (p = 0.615). The median survival for the lowest SES was 8.5 months, compared to 8.8 months for the highest SES group. The age- and sex-adjusted proportional-hazards model showed statistically significant difference in HCC survival among the SES groups, with hazard ratio 0.905 (95% confidence intervals 0.821, 0.998) when comparing highest to lowest SES group. Further adjustments indicated that potentially curative treatment was the likely explanation for the association between SES and HCC survival. Conclusions/Significance: Our findings suggest that a 10% HCC survival advantage exists for the higher SES groups. This association between SES and HCC survival is most likely a reflection of lack of access to care for low SES groups, revealing inequities in the Canadian healthcare system.

Suggested Citation

  • Nathaniel Jembere & Michael A Campitelli & Morris Sherman & Jordan J Feld & Wendy Lou & Stuart Peacock & Eric Yoshida & Murray D Krahn & Craig Earle & Hla-Hla Thein, 2012. "Influence of Socioeconomic Status on Survival of Hepatocellular Carcinoma in the Ontario Population; A Population-Based Study, 1990–2009," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-10, July.
    • Handle: RePEc:plo:pone00:0040917
    DOI: 10.1371/journal.pone.0040917
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    References listed on IDEAS

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    1. Krieger, N., 1992. "Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology," American Journal of Public Health, American Public Health Association, vol. 82(5), pages 703-710.
    2. Gorey, K.M. & Luginaah, I.N. & Bartfay, E. & Fung, K.Y. & Holowaty, E.J. & Wright, F.C. & Hamm, C. & Kanjeekal, S.M., 2011. "Effects of socioeconomic status on colon cancer treatment accessibility and survival in Toronto, Ontario, and San Francisco, California, 1996-2006," American Journal of Public Health, American Public Health Association, vol. 101(1), pages 112-119.
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    1. Hla-Hla Thein & Kika Anyiwe & Nathaniel Jembere & Brian Yu & Prithwish De & Craig C Earle, 2017. "Effects of socioeconomic status on esophageal adenocarcinoma stage at diagnosis, receipt of treatment, and survival: A population-based cohort study," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-20, October.
    2. Hla-Hla Thein & Yao Qiao & Ahmad Zaheen & Nathaniel Jembere & Gonzalo Sapisochin & Kelvin K W Chan & Eric M Yoshida & Craig C Earle, 2017. "Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-20, October.

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