Census Tract-Level Persistent Poverty and Liver Cancer Survival: A Population-Based Study

Liver cancer incidence and mortality are rising in the United States, with marked racial and socioeconomic disparities. Persistent poverty, defined as communities in which ≥20% of residents have lived below the federal poverty line for ≥30 years, is an important but understudied contextual determinant of cancer survival. This study examined the association between census tract-level persistent poverty and liver cancer survival.

We analyzed 73,695 adult, population-based patients with liver cancer ages ≥20 years, diagnosed between 2006 and 2019 in the Surveillance, Epidemiology, and End Results 17 Registries. Persistent poverty status was assigned by residence at diagnosis. Cancer-specific and overall survival were estimated using Kaplan-Meier and Cox models, adjusting for demographic factors, stage at diagnosis, and initial treatment. We evaluated effect modification by age, sex, race/ethnicity, rurality, and stage at diagnosis.

Over 168,715 person-years, 56,373 deaths occurred, of which 81% were cancer-specific. Eleven percent of patients lived in persistent poverty tracts. The median cancer-specific survival was 16 months in persistent poverty tracts versus 22 months in nonpersistent tracts (P < 0.001). In fully adjusted models, persistent poverty was associated with 9% higher cancer-specific mortality (HR = 1.09; 95% CI, 1.06-1.12) and 11% higher all-cause mortality (HR = 1.11; 95% CI, 1.09-1.14). Associations were strongest in patients <65 years and with localized disease, with no significant differences by race/ethnicity, sex, or rurality.

Living in a persistent poverty census tract is associated with worse liver cancer survival, particularly among younger patients and those with localized disease.

Interventions and policies targeting economically disadvantaged communities may be important for reducing liver cancer survival disparities.