Ethnic and socioeconomic disparities in survival outcomes among patients under 65 years with intrahepatic cholangiocarcinoma: A SEER analysis.

Abstract

e13745 Background: Intrahepatic cholangiocarcinoma (iCCA), the second most prevalent primary liver tumor, is associated with high mortality rates despite recent advances in treatment. The influence of socioeconomic factors on prognosis in iCCA remains understudied. Economic disparities among individuals under 65 years who are typically ineligible for Medicare, may influence healthcare outcomes. This study examines the effects of race and income in addition to common prognostic variables on the overall survival (OS) in patients with iCCA under 65. Methods: Data was extracted from the SEER 22 database which included iCCA patients aged 20–64 years. The Kaplan-Meier analysis was applied to estimate the median survival time. Log rank test, univariate and multivariate Cox proportional hazards models were used to evaluate the association of age, ethnicity, income, and stage with overall survival. Results: A total of 8,585 iCCA patients were identified: Hispanic: 22%, Non-Hispanic White (NHW) 57%, Non-Hispanic Black (NHB) 10%, Asian 10%, Native American 1%; 53% Males; median age was 57 years (range: 20–64 years) and median household income was $77,500 (interquartile range [IQR]: $62,500–$92,500). The estimated median OS (mOS) was 10 months (95% CI:10, 11). Cancer stage was highly associated with survival, other significant prognostic factors were age and gender as shown in Table 1. NHB (mOS: 8 months, 95% CI: 7-10) and Native American (mOS: 8 months, 95% CI 5-15) patients had the poorest outcomes, followed by Hispanics (mOS 9 months, 95% CI 8-10). NHW and Asian patients fared better (mOS 11 and 12 months, respectively) (p value < 0.001). Patients with household income ≥$75,000 had better survival outcomes than those earning < $75,000 annually (p value < 0.001). On multivariate COX analysis, age < 55, females, localized disease, Asian or Caucasian ethnicity, and household income ≥$75,000 were independently associated with a lower risk of death. Conclusions: This study identifies ethnic and socioeconomic disparities in iCCA patients that may impact prognosis. These findings highlight the need for targeted interventions to address inequities, ensuring access to care and improving survival outcomes for underserved populations. Variable Category HR 95% CI (HR) P-Value Age 55-64 vs 20-34 1.281 1.109-1.480 <0.001 Sex Male vs Female 1.253 1.194-1.314 <0.001 Stage Localized vs Distant 0.295 0.276–0.315 <0.001 Regional vs Distant 0.572 0.540–0.605 <0.001 Race Non-Hispanic Black vs Hispanic 0.981 0.897–1.073 0.676 Non-Hispanic White vs Hispanic 0.873 0.821–0.928 <0.001 Income Group <$50,000 vs $50,000–$74,999 1.092 1.003-1.188 0.041 $75,000–$99,999 vs $50,000–$74,999 0.939 0.884–0.966 <0.001 ≥$100,000 vs $50,000–$74,999 0.855 0.798–0.916 <0.001