Disparities in incidence and stage at presentation of hepatocellular carcinoma: A SEER-based study of disaggregated AANHPI populations.

Abstract

e13734 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in the United States. The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population bears a disproportionately high burden of HCC compared to non-Hispanic White (NHW) populations, driven in part by a higher prevalence of hepatitis B infection, variable access to surveillance, and differences in liver disease etiology. AANHPI populations are frequently analyzed as an aggregated racial group despite substantial heterogeneity across subgroups. This has previously been shown to mask inequities. We examined disparities in HCC stage at presentation using disaggregated AANHPI subgroups within the Surveillance, Epidemiology, and End Results (SEER) program. Methods: We conducted a retrospective, population-based study using SEER Data from 17 registries (2000–2022). Race and ethnicity were analyzed using disaggregated categories, with NHW patients as the reference. Stage at diagnosis was modeled as an ordinal outcome (localized, regional, distant). Ordinal logistic regression estimated adjusted odds ratios (AORs) and 95% confidence intervals, adjusting for age, sex, median household income, and rural versus urban residence. Higher AORs indicated greater odds of advanced-stage disease. Due to limited population denominators, incidence rates were calculated with aggregated AANHPI populations. Results: Aggregate AANHPI populations had a higher incidence of HCC (9.4 per 100,000) than NHW patients (3.8 per 100,000). In adjusted analysis, race and ethnicity were significantly associated with stage at presentation. Compared with NHW patients, Non-Hispanic Black patients had lower odds of advanced-stage disease, while Hispanic White patients had higher odds. Among AANHPI subgroups, Chinese and Vietnamese patients had higher odds of advanced-stage presentation, while Filipino, Laotian, and Pacific Islander patients had lower odds. Conclusions: In this SEER-based analysis, race and ethnicity were independently associated with stage at presentation of HCC. Disaggregation of AANHPI populations revealed heterogeneity that would otherwise be obscured in aggregate analyses. These findings underscore the need for subgroup-specific surveillance and prevention strategies to reduce disparities and combat inequities in advanced-stage HCC diagnosis. Association between race/ethnicity and advanced stage at diagnosis. Race/Ethnicity Adjusted Odds Ratio 95% CI p-value Black 0.88 0.85–0.91 <0.001 Hispanic White 1.1 1.07–1.14 <0.001 American Indian/Alaska Native 1.11 0.99–1.23 0.067 Chinese 1.17 1.10–1.25 <0.001 Vietnamese 1.07 1.01–1.15 0.029 Filipino 0.92 0.85–0.99 0.029 Laotian 0.72 0.59–0.89 0.002 Pacific Islander 0.78 0.66–0.92 0.004 Other Asian American 1.20 1.05–1.37 0.008 *Other AANHPI subgroups without statistical significance.