DOI: 10.6084/m9.figshare.27231087.v1
title: Race/ethnicity and socioeconomic position in emergency department utilization in patients with hepatocellular carcinoma

description: <b>Aim:</b> Evaluate the association of race/ethnicity and socioeconomic position (SEP) on emergency department (ED) visits for patients with hepatocellular carcinoma (HCC), which may reflect access to and quality of cancer care. <b>Materials & methods:</b> Patients with HCC identified from a commercial multi-payer claims database between 2015 and 2018 were matched to near-neighborhood social determinants of health (SDOH) and stratified by race/ethnicity and SEP (proxied by annual household income). Analyses evaluated the effect of race/ethnicity and SEP on ED utilization, adjusting for SDOH, demographic and clinical characteristics using multivariable regression methods. <b>Results:</b> A total of 22,247 patients were included. Black and Hispanic patients had 43 and 18% higher ED utilization than White patients at higher-income levels (p &lt; 0.01); these differences were nonsignificant at lower-income. Regardless of income level, Asian patients had lower ED utilization. <b>Conclusion:</b> Further research on the intersectionality between race/ethnicity, SEP and other SDOH may guide structural-level interventions to address health inequities. Health disparities among racial/ethnic minorities have been observed in patients with hepatocellular carcinoma (HCC). We conducted a real-world retrospective insurance claims study of more than 22,200 adult patients with HCC between 2015 and 2018. We evaluated the association of race/ethnicity and socioeconomic position (measured by income level) with emergency department (ED) utilization. Our study consisted of 69% White, 14% Black, 7% Hispanic, 6% Asian and 4% other patient populations. Black and Hispanic patients had the highest number of ED visits, followed by White and Asian patients. Compared with White patients, ED visits were 27% higher for Black, 17% higher for Hispanic and 36% lower for Asian patients. Compared with low income, middle income was associated with 4% more and high income with 6% less ED use, regardless of race/ethnicity. At higher income levels, Black and Hispanic but not Asian patients demonstrated higher ED use than White patients. These findings suggest that improved socioeconomic position of Black and Hispanic patients may not provide as protective an effect on health outcomes, potentially due to structural health inequities. Emergency department use for liver cancer care is higher in Black and Hispanic patients compared with White patients regardless of socioeconomic status, suggesting ongoing structural racial health disparities despite improved socioeconomic position. Despite advances in diagnosis and treatment of hepatocellular carcinoma (HCC), disparities in care access, utilization and health outcomes persist. This study evaluated the association of race/ethnicity and socioeconomic position on incidence of emergency department (ED) visits, which may reflect access to and quality of cancer care. Compared with White patients, ED visits were higher for Black (IRR: 1.27) and Hispanic patients (IRR: 1.17) and lower for Asian patients (IRR: 0.67). When stratified by income, Black and Hispanic patients had higher ED utilization than White patients at higher income levels, but these differences became insignificant at lower-income levels. Asian patients had lower ED utilization regardless of income. In summary, racial/ethnicity differences in ED utilization were more pronounced at higher income levels, suggesting racial disparities may differ by socioeconomic position. Further research is needed to understand the intersectionality between race/ethnicity, socioeconomic position, and other social determinants of health, to guide structural-level interventions to address health inequities.