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      Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival

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          Abstract

          Background

          Liver cancer incidence increased in the US from 1975 through 2015 with heterogeneous rates across subpopulations. Upstream or distal area-level factors impact liver cancer risks.

          Objective

          The aim of this study was to examine the association between area-level deprivation and hepatocellular carcinoma (HCC) incidence and survival. We also explored the association between area deprivation and treatment modalities.

          Methods

          Louisiana Tumor Registry identified 4,151 adult patients diagnosed with malignant HCC from 2011 to 2020 and linked residential address to census tract (CT)-level Area Deprivation Index (ADI) categorized into quartiles (Q1 = least deprived). ANOVA examined the association between ADI quartile and CT age-adjusted incidence rate (AAIR) per 100,000. Chi-square tested the distribution of demographic and clinical characteristics across ADI quartiles. Kaplan–Meier and proportional hazard models evaluated survival by deprivation quartile.

          Results

          Among the 1,084 CTs with incident HCC, the average (SD) AAIR was 8.02 (7.05) HCC cases per 100,000 population. ADI was observed to be associated with incidence, and the mean (SD) AAIR increased from 5.80 (4.75) in Q1 to 9.26 (7.88) in Q4. ADI was also associated with receipt of surgery ( p < 0.01) and radiation ( p < 0.01) but not chemotherapy ( p = 0.15). However, among those who received chemotherapy, people living in the least deprived areas began treatment approximately 10 days sooner than those living in other quartiles. Q4 patients experienced the worst survival with a median of 247 (95% CI 211–290) days vs. Q1 patients with a median of 474 (95% CI 407–547) days ( p < 0.0001). Q4 had marginally poorer survival (HR 1.20, 1.05–1.37) than Q1 but the association became non-significant (HR 1.12, 0.96–1.30) when adjusted for rurality, liquor store density, sex, race/ethnicity, age, insurance, BMI, stage, hepatitis diagnosis, and comorbidities.

          Conclusion

          Increasing neighborhood (CT) deprivation (ADI) was observed to be associated with increased HCC incidence and poorer HCC survival. However, the association with poorer survival becomes attenuated after adjusting for putative confounders.

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          Most cited references28

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          Cancer statistics, 2023

          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.
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            The Social Determinants of Health: It's Time to Consider the Causes of the Causes

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              Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas

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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2563415Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/2614135Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/1545355Role: Role: Role: Role: Role: Role:
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                URI : https://loop.frontiersin.org/people/434173Role: Role: Role: Role:
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                06 February 2024
                2024
                : 14
                : 1331049
                Affiliations
                [1] 1 Department of Epidemiology, College of Public Health, University of Nebraska Medical Center , Omaha, NE, United States
                [2] 2 Louisiana Tumor Registry, Epidemiology Program, School of Public Health at Louisiana State University (LSU) Health Sciences Center-New Orleans , New Orleans, LA, United States
                [3] 3 Department of Internal Medicine, Division of Oncology/Hematology, College of Medicine, University of Nebraska Medical Center , Omaha, NE, United States
                Author notes

                Edited by: Raluca Ioana Stefan-van Staden, National Institute of Research and Development for Electrochemistry and Condensed Matter (INCEMC), Romania

                Reviewed by: Jiasheng Cao, Zhejiang University, China

                Alfredo Caturano, University of Campania Luigi Vanvitelli, Italy

                Sok King Ong, Universiti Brunei Darussalam, Brunei

                Jiang Chen, Zhejiang University, China

                *Correspondence: Kendra L. Ratnapradipa, kendra.ratnapradipa@ 123456unmc.edu
                Article
                10.3389/fonc.2024.1331049
                10878418
                38380357
                5d9ae48b-e2c5-4e88-88b4-cbe71065fc4d
                Copyright © 2024 Ratnapradipa, Li, Hsieh, Tenner and Peters

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 14 November 2023
                : 16 January 2024
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 29, Pages: 10, Words: 4773
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The work was supported in part by the National Cancer Institute (R01CA237318). Additional support was provided in part by Louisiana State University Health Sciences Center-New Orleans, the Centers for Disease Control and Prevention under cooperative agreement of the National Program of Cancer Registries grant number NU58DP006332, and the National Cancer Institute’s contract number HHSN2612018000071. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.
                Categories
                Oncology
                Original Research
                Custom metadata
                Cancer Epidemiology and Prevention

                Oncology & Radiotherapy
                area deprivation index (adi),hepatocellular carcinoma (hcc),incidence,social determinants of health,survival

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