ArticleBMJ open gastroenterology2024
Health literacy and cumulative social disadvantage are associated with survival and transplant in patients with hepatocellular carcinoma: a prospective study.
Article in BMJ open gastroenterology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The importance of social vulnerability and exclusion in cancer prognosis and survival: a scoping review.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Review
- Exploring patient and provider narratives: a qualitative study identifying barriers in liver transplantation referral.BMC health services research · 2026Article
- Hepatocellular carcinoma surveillance: a health economic evaluation.Clinical and molecular hepatology · 2026Review
- Neighborhood Disadvantage and Access to Liver Transplant Referral for Severe Alcohol-Associated Hepatitis.JAMA network open · 2026Observational
- Exploratory analysis of allostatic load and mortality in patients with hepatocellular carcinoma.BMC research notes · 2026Article
- Exploring Patient and Provider Narratives: A Qualitative Study Identifying Barriers in Liver Transplantation Referral.Research square · 2025Article
- A large language model-based approach to quantifying the effects of social determinants in liver transplant decisions.NPJ digital medicine · 2025Article
- Educational, financial, logistical, emotional, and social needs among patients with hepatocellular carcinoma.Hepatology communications · 2025Article
- Feasible and acceptable social drivers of health screening among patients with chronic liver disease.Hepatology communications · 2025Article
- The Role of Patient-Reported Outcomes in Cirrhosis.The American journal of gastroenterology · 2025Review
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Authors and funding
12 authors.
Funding
Abstract
objectiveTo investigate how individual social determinants of health (SDOH) and cumulative social disadvantage (CSD) affect survival and receipt of liver transplant (LT) in patients with hepatocellular carcinoma (HCC).
methodsWe enrolled 139 adult patients from two Indianapolis hospital systems between June 2019 and April 2022. Structured questionnaires collected SDOH and social risk factor data. We compared SDOH and CSD by race, gender and disease aetiology, assigning one point per adverse SDOH. Multivariable competing risk survival analysis assessed associations between SDOH, CSD, survival and LT receipt.
resultsBlack patients experienced higher CSD than white patients in the cohort (5.4±2.5 vs 3.2±2.1, p<0.001). Black patients were significantly more likely to have household incomes <US$15 000 per year (52.6% vs 18.3%, p=0.003), to be insured by Medicaid (57.9% vs 33.0%, p=0.04), and to live in high Social Deprivation Index areas (68.4% vs 17.5%, p<0.001) than white patients. Patients with hepatitis C virus and alcohol-related liver disease had more adverse SDOH than those with metabolic dysfunction-associated steatotic liver disease, while there were no significant differences by gender. On multivariable analysis, a higher health literacy score was a significant predictor of survival (HR 2.54, 95% CI 1.19 to 5.43 CI, p=0.02) and higher CSD was associated with a lower probability of receipt of LT (HR 0.80, 95% CI 0.68 to 0.95, p=0.01).
conclusionsThere are significant racial and aetiology-related differences in SDOH burden. Low health literacy and high CSD are linked to worse outcomes in HCC patients. Health literacy screening and targeted interventions for those with high CSD could improve LT access and survival rates.
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