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

Area of Science:

• Oncology
• Public Health
• Socioeconomic Determinants of Health

Background:

• Liver cancer incidence and mortality are increasing in the U.S., with significant racial and socioeconomic disparities.
• Persistent poverty, defined as communities with ≥20% federal poverty line residents for ≥30 years, is an understudied factor in cancer survival.
• This study investigates the association between persistent poverty at the census tract level and liver cancer survival outcomes.

Purpose of the Study:

• To examine the relationship between census tract-level persistent poverty and liver cancer survival.
• To determine if persistent poverty impacts cancer-specific and overall mortality.
• To identify demographic and clinical factors that modify this association.

Main Methods:

• Analysis of 73,695 adult liver cancer patients diagnosed between 2006-2019 from the SEER 17 Registries.
• Assignment of persistent poverty status based on patient residence at diagnosis.
• Survival analysis using Kaplan-Meier and Cox models, adjusting for covariates and evaluating effect modification.

Main Results:

• Eleven percent of patients resided in persistent poverty tracts.
• Median cancer-specific survival was significantly lower in persistent poverty tracts (16 months) versus non-persistent tracts (22 months).
• Persistent poverty was associated with a 9% increase in cancer-specific mortality and an 11% increase in all-cause mortality, particularly in younger patients (<65) and those with localized disease.

Conclusions:

• Residence in a persistent poverty census tract is independently associated with poorer liver cancer survival.
• Interventions and policies addressing socioeconomic disadvantage are crucial for mitigating liver cancer survival disparities.
• The findings underscore the importance of considering socioeconomic context in cancer care and policy.