The risk of dying from the most common form of primary liver cancer is about 30 percent higher for patients with low household income compared to those with middle or high household income, according to a study at the University of Gothenburg.
Each year, some 500–550 people in Sweden are diagnosed with what is known as hepatocellular carcinoma, or HCC for short, which is the most common form of primary liver cancer, in other words, a cancer that starts in the liver. Three out of four of those affected are men.
The research team has previously shown that HCC is about five times more common in those with low household income compared to those with high household income. The aim of this study was to examine how diagnosis, treatment, and survival are affected by income, education, ethnicity, and other sociodemographic factors.
The study found that patients with low household income were considerably less likely to be diagnosed with HCC at an early stage and to be offered curative treatment. Low household income was also linked to 29 percent higher mortality compared to middle or high household income.
Efforts required to ensure equal care
The study lead, Juan Vaz, is a researcher in community medicine and public health at Sahlgrenska Academy at the University of Gothenburg and a specialist physician at Halland Hospital in Halmstad:
"The study clearly shows that socioeconomic differences are strongly linked to less favorable health outcomes at all levels of care for patients with HCC in Sweden. The results underline the need for further efforts to ensure that care is truly equal and accessible to all, regardless of socioeconomic background," he says.
The study, published in The Lancet Regional Health – Europe, encompasses all adult patients with HCC included in the Swedish National Liver Registry (SweLiv) between 2011 and 2021, a total of 5,490 patients.
The socioeconomic data were retrieved from other national health registries and demographic databases. The results were adjusted for factors including underlying liver disease, comorbidities, and specific tumor characteristics that can affect the choice of treatment and prognosis.
Targeted screening in deprived areas
The main risk factor for HCC is cirrhosis of the liver, often simply referred to as cirrhosis, which is a pathological breakdown of the liver caused by chronic liver inflammation resulting from, for example, high alcohol consumption or a hepatitis virus infection.
The research team is now employing advanced statistical methods to select areas in Sweden where screening for liver cirrhosis would offer the greatest benefits. Pilot studies are also being planned.
"Targeted screening for cirrhosis of the liver in socioeconomically deprived areas can lead to early HCC diagnosis, which in turn can increase the chances of access to curative treatments, as well as all the other health benefits linked to an early cirrhosis diagnosis," says Juan Vaz.