Cancer
Establishing a linked, pooled, longitudinal electronic health record (EHR) cohort to study racial/ethnic disparities in hepatocellular carcinoma (HCC) surveillance Enyao Zhang* Enyao Zhang Caroline A. Thompson Mindy Hebert-Derouen Alison Canchola Aly Cortella Pushkar Inamdar Janet Chu Sixiang Nie Mai Vu Ma Somsouk Michele Tana Anna Rubinsky Iona Cheng Mi-Ok Kim Mark Segal Chanda Ho Yihe G. Daida Su-Ying Liang Hashem El-Serag Scarlett Gomez Salma Shariff-Marco
Hepatocellular carcinoma (HCC) is a major contributor of cancer deaths in the U.S. Yet, uptake of guideline-recommended surveillance is low among those at higher risk of developing HCC, particularly in racial/ethnic minoritized groups. Surveillance underuse highlights a complex mix of patient, provider, healthcare system, and neighborhood level factors. Despite known racial/ethnic disparities in guideline surveillance, in-depth analysis identifying specific contributory factors is limited. We established a novel real world data resource to identify contributors to racial/ethnic disparities in HCC surveillance among a geographically and racially/ethnically diverse high-risk cohort. The study combined electronic health record (EHR) data from Sutter Health and Kaiser Permanente, with particularly robust representation of Hispanic and disaggregated Asian American groups, linked with state cancer registry data and neighborhood data. We included individuals from 2000-2017 with an in-person encounter, no prior liver cancer, and with clinical indication of cirrhosis, chronic hepatitis B or C, or a high Fib-4 score (indicating advanced liver fibrosis). Surveillance, defined as biannual ultrasounds, was measured by ever/never surveilled and time up to date with surveillance. Multivariable models will assess surveillance adherence disparities across racial/ethnic groups. Of the 73,048 high-risk patients identified (12,728 in Kaiser Permanente and 60,320 in Sutter Health), approximately 90% had cirrhosis, hepatitis B or C. Most were born between 1945-1965, with a balanced sex ratio and diverse racial/ethnic composition, including 21% Asian American, 8% Hispanic, and 5% Black. Utilizing detailed EHR data, this study creates a diverse cohort, differing from prior HCC surveillance research that relied on administrative and cancer registry data. Results will provide for a better understanding of racial/ethnic disparities and suggest multilevel factors for adherence improvements.