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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Racial and ethnic differences in social determinants of health among patients with HCC
Mohammed Al-Hasan1, Nicole E Rich1,2, Gloria Figueroa3,4
1Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Insights
Black and Hispanic patients with hepatocellular carcinoma (HCC) experience higher medical mistrust, treatment barriers, and lower health literacy. Addressing these disparities requires understanding the complex interplay of race, ethnicity, and healthcare access.
Area of Science:
- Oncology
- Health Disparities Research
- Health Services Research
Background:
- Hepatocellular carcinoma (HCC) disproportionately affects racial and ethnic minority populations, often presenting with advanced disease and reduced treatment access.
- Existing research indicates disparities in HCC outcomes linked to tumor burden and treatment utilization among minority groups.
- This study investigates racial and ethnic variations in medical mistrust, treatment barriers, and health literacy within the HCC patient population.
Purpose of the Study:
- To explore and quantify racial and ethnic differences in medical mistrust among patients diagnosed with HCC.
- To identify and compare barriers to accessing HCC treatment across different racial and ethnic groups.
- To assess the prevalence of limited health literacy in relation to race and ethnicity among HCC patients.
Main Methods:
- A multicenter survey was administered to patients newly diagnosed with HCC between September 2018 and July 2023 across four major U.S. health systems.
- The survey utilized validated instruments, including the Group-Based Medical Mistrust Scale (GBMMS) and the CHEW Assessment of Health Literacy, alongside questions on HCC treatment barriers.
- Multivariable logistic regression analyses were performed to determine the association between race/ethnicity and the measured survey outcomes.
Main Results:
- The study included 833 out of 1245 eligible patients (66.9% response rate), with demographic breakdown: 45.9% Hispanic, 35.9% White, and 14.2% Black.
- Black and Hispanic patients reported significantly higher rates of medical mistrust compared to White patients (14.2% and 3.3% vs. 0.7%, p<0.001).
- Black race was strongly associated with high mistrust (OR: 19.2), while Hispanic ethnicity showed a non-significant trend (OR: 3.72). Common barriers included pain concerns, financial burden, and time commitment. Limited health literacy was prevalent, particularly among Hispanic (46.8%) and Black (41.0%) patients compared to White patients (26.2%).
Conclusions:
- Significant disparities in medical mistrust, treatment barriers, and health literacy exist among Black and Hispanic patients with HCC.
- These findings underscore the critical need to understand the intersection of race, ethnicity, and socioeconomic factors in HCC care.
- Addressing these multifaceted barriers is essential for mitigating HCC disparities and improving equitable health outcomes.
Background:
Racial and ethnic minority populations are disproportionately impacted by HCC due to more advanced tumor burden and underuse of treatments. We explored racial and ethnic differences in medical mistrust, barriers to treatment, and health literacy among patients with HCC.
Methods:
We conducted a multicenter survey among patients with newly diagnosed HCC between September 2018 and July 2023 at 4 large U.S. health systems. The survey assessed medical mistrust [Group-Based Medical Mistrust Scale (GBMMS)], health literacy (CHEW Assessment of Health Literacy), and barriers to HCC treatment. We performed multivariable logistic regression to evaluate associations between race and ethnicity and survey measures.
Results:
Of 1245 eligible patients, 833 (66.9%) completed the survey (45.9% Hispanic, 35.9% White, and 14.2% Black). A higher proportion of Black and Hispanic patients had high medical mistrust than White patients (14.2% and 3.3% vs. 0.7%, respectively; p<0.001). In multivariable analysis, Black race (OR: 19.2, 95% CI: 4.2-87.7) but not Hispanic ethnicity (OR: 3.72, 95% CI: 0.80-17.2) was significantly associated with high mistrust. Compared to White patients, Black and Hispanic patients both reported greater barriers to HCC treatment, with the most common barriers being concerns about pain (41.6%), financial burden (37.6%), and time commitment (31.1%). Limited health literacy was reported by 38.1% of patients (46.8% Hispanic, 41.0% Black, 26.2% White; p<0.001).
Conclusions:
Medical mistrust, barriers to treatment, and limited health literacy are prevalent among Black and Hispanic patients with HCC. Understanding the interplay between race, ethnicity, and these factors is essential to address HCC disparities.
