Skip to main content

Advertisement

SpringerLink
Log in

Racial and Sex Disparities in Hepatocellular Carcinoma in the USA

  • Hepatic Cancer (N Parikh, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this review, we aim to provide a summary of the current literature on race and gender disparities in hepatocellular carcinoma (HCC) incidence, stage at diagnosis, treatment, and prognosis in the USA.

Recent Findings

HCC incidence rates are rising in the USA in all racial/ethnic groups except for Asian/Pacific Islanders, with disproportionate rises and the highest rates among Hispanics compared to Blacks and non-Hispanic Whites. There are striking sex disparities in HCC incidence and mortality; however, with the shifting epidemiology of HCC risk factors in the USA, there is recent evidence that HCC is trending towards less male predominance, particularly among younger birth cohorts. Despite significant advances in HCC treatment over the past decade, disparities in HCC surveillance and treatment receipt persist among racial and ethnic minorities and the socioeconomically disadvantaged. Black patients continue to experience worse survival outcomes than non-Black patients with HCC.

Summary

There are significant racial and gender disparities in HCC incidence, treatment, and mortality in the USA. Though these disparities are well-documented, data are still limited on the specific determinants driving disparities in HCC. To achieve health equity for all patients with HCC, we must advance beyond simply reporting on disparities and begin implementing targeted interventions to eliminate disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Kulik L, El-Serag HB. Epidemiology and management of hepatocellular carcinoma. Gastroenterology. 2019;156:477–491.e1 Comprehensive, up-to-date review on trends in risk factors, diagnosis, and therapeutic advances in HCC.

    PubMed  Google Scholar 

  2. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67:123–33.

    CAS  PubMed  Google Scholar 

  3. Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiol Biomark Prev. 2016;25:16.

    Google Scholar 

  4. Chang ET, Keegan THM, Gomez SL, le GM, Clarke CA, So SKS, et al. The burden of liver cancer in Asians and Pacific Islanders in the Greater San Francisco Bay Area, 1990 through 2004. Cancer. 2007;109:2100–8.

    PubMed  PubMed Central  Google Scholar 

  5. • Petrick JL, Kelly SP, Altekruse SF, et al. Future of hepatocellular carcinoma incidence in the United States forecast through 2030. J Clin Oncol. 2016;34:1787–94 A summary of trends in HCC incidence among all racial/ethnic groups and forecasts expected trends throught the next decade.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Wasley A, Kruszon-Moran D, Kuhnert W, Simard EP, Finelli L, McQuillan G, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis. 2010;202:192–201.

    PubMed  Google Scholar 

  7. El-Serag HB, Lau M, Eschbach K, et al. Epidemiology of hepatocellular carcinoma in Hispanics in the United States. Arch Intern Med. 2007;167:1983–9.

    PubMed  Google Scholar 

  8. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142:1264–1273.e1.

    PubMed  PubMed Central  Google Scholar 

  9. Rich NE, Yopp AC, Singal AG, et al. Hepatocellular carcinoma incidence is decreasing among younger adults in the United States. Clin Gastroenterol Hepatol. 2020;18:242–248.e5.

    PubMed  Google Scholar 

  10. Jim MA, Perdue DG, Richardson LC, Espey DK, Redd JT, Martin HJ, et al. Primary liver cancer incidence among American Indians and Alaska Natives, US, 1999–2004. Cancer. 2008;113:1244–55.

    PubMed  Google Scholar 

  11. McMahon BJ, Bulkow L, Harpster A, et al. Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: a 16-year population-based study. Hepatology. 2000;32:842–6.

    CAS  PubMed  Google Scholar 

  12. McMahon BJ, Bulkow LR, Singleton RJ, et al. Elimination of hepatocellular carcinoma and acute hepatitis B in children 25 years after a hepatitis B newborn and catch-up immunization program. Hepatology. 2011;54:801–7.

    PubMed  Google Scholar 

  13. El-Serag HB, Sardell R, Thrift AP, Kanwal F, Miller P. Texas has the highest hepatocellular carcinoma incidence rates in the USA. Dig Dis Sci. 2020. https://doi.org/10.1007/s10620-020-06231-4.

  14. White DL, Thrift AP, Kanwal F, et al. Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012. Gastroenterology. 2017;152:812–820.e5.

    PubMed  Google Scholar 

  15. Setiawan VW, Wei PC, Hernandez BY, Lu SC, Monroe KR, le Marchand L, et al. Disparity in liver cancer incidence and chronic liver disease mortality by nativity in Hispanics: the multiethnic cohort. Cancer. 2016;122:1444–52.

    PubMed  PubMed Central  Google Scholar 

  16. Shebl FM, Capo-Ramos DE, Graubard BI, McGlynn KA, Altekruse SF. Socioeconomic status and hepatocellular carcinoma in the United States. Cancer Epidemiol Biomark Prev. 2012;21:1330–5.

    Google Scholar 

  17. Danos D, Leonardi C, Gilliland A, Shankar S, Srivastava RK, Simonsen N, et al. Increased risk of hepatocellular carcinoma associated with neighborhood concentrated disadvantage. Front Oncol. 2018;8:375.

    PubMed  PubMed Central  Google Scholar 

  18. Yang B, Liu JB, So SK, Han SS, Wang SS, Hertz A, et al. Disparities in hepatocellular carcinoma incidence by race/ethnicity and geographic area in California: implications for prevention. Cancer. 2018;124:3551–9.

    PubMed  PubMed Central  Google Scholar 

  19. Cook MB, Dawsey SM, Freedman ND, Inskip PD, Wichner SM, Quraishi SM, et al. Sex disparities in cancer incidence by period and age. Cancer Epidemiol Biomark Prev. 2009;18:1174–82.

    Google Scholar 

  20. McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology. 2020. https://doi.org/10.1002/hep.31288.

  21. Mittal S, El-Serag HB. Epidemiology of HCC: consider the population. J Clin Gastroenterol. 2013;47:S2–6.

    PubMed  PubMed Central  Google Scholar 

  22. Zhang X, El-Serag HB, Thrift AP. Sex and race disparities in the incidence of hepatocellular carcinoma in the United States examined through Age–Period–Cohort Analysis. Cancer Epidemiol Biomark Prev. 2020;29(1):88–94. https://doi.org/10.1158/1055-9965.

  23. Welzel TM, Graubard BI, Quraishi S, Zeuzem S, Davila JA, el-Serag HB, et al. Population-attributable fractions of risk factors for hepatocellular carcinoma in the United States. Am J Gastroenterol. 2013;108:1314–21.

    PubMed  PubMed Central  Google Scholar 

  24. Naugler WE, Sakurai T, Kim S, Maeda S, Kim K, Elsharkawy AM, et al. Gender disparity in liver cancer due to sex differences in MyD88-dependent IL-6 production. Science. 2007;317:121–4.

    CAS  PubMed  Google Scholar 

  25. Kanda T, Jiang X, Yokosuka O. Androgen receptor signaling in hepatocellular carcinoma and pancreatic cancers. World J Gastroenterol: WJG. 2014;20:9229.

    PubMed  Google Scholar 

  26. Yip TC, Wong GL, Chan HL, Tse YK, Liang LY, Hui VW, et al. Elevated testosterone increases risk of hepatocellular carcinoma in men with chronic hepatitis B and diabetes mellitus. J Gastroenterol Hepatol. 2020. https://doi.org/10.1111/jgh.15079.

  27. Hassan MM, Botrus G, Abdel-Wahab R, Wolff RA, Li D, Tweardy D, et al. Estrogen replacement reduces risk and increases survival times of women with hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2017;15:1791–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Petrick JL, Florio AA, Zhang X, Zeleniuch-Jacquotte A, Wactawski-Wende J, Van Den Eeden SK, et al. Associations between prediagnostic concentrations of circulating sex steroid hormones and liver cancer among post-menopausal women. Hepatology. 2020;72(2):535–47. https://doi.org/10.1002/hep.31057.

  29. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol. 2013;47(Suppl):S2–6.

    PubMed  PubMed Central  Google Scholar 

  30. Makarova-Rusher OV, Altekruse SF, McNeel TS, et al. Population attributable fractions of risk factors for hepatocellular carcinoma in the United States. Cancer. 2016;122:1757–65.

    PubMed  PubMed Central  Google Scholar 

  31. Younossi ZM. Non-alcoholic fatty liver disease – a global public health perspective. J Hepatol. 2019;70:531–44.

    PubMed  Google Scholar 

  32. • Rich NE, Oji S, Mufti AR, et al. Racial and ethnic disparities in nonalcoholic fatty liver disease prevalence, severity, and outcomes in the United States: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16:198–210.e2 A large meta-analysis describing disparities in NAFLD/NASH., with the highest prevalence and severity in Hispanics compared to non-Hispanics.

    PubMed  Google Scholar 

  33. Wu EM, Wong LL, Hernandez BY, Ji JF, Jia W, Kwee SA, et al. Gender differences in hepatocellular cancer: disparities in nonalcoholic fatty liver disease/steatohepatitis and liver transplantation. Hepatoma Res. 2018;4:66.

    PubMed  PubMed Central  Google Scholar 

  34. •• Rich NE, Murphy CC, Yopp AC, et al. Sex disparities in presentation and prognosis of 1110 patients with hepatocellular carcinoma. Aliment Pharmacol Ther. 2020;52:701–9 Large cohort study describing sex disparities in HCC prognosis at two large US health systems demonstrated women with HCC have better overall survival compared to men even after adjusting for tumor stage and liver disease severity.

    CAS  PubMed  Google Scholar 

  35. Ladenheim MR, Kim NG, Nguyen P, le A, Stefanick ML, Garcia G, et al. Sex differences in disease presentation, treatment and clinical outcomes of patients with hepatocellular carcinoma: a single-centre cohort study. BMJ Open Gastroenterol. 2016;3:e000107.

    PubMed  PubMed Central  Google Scholar 

  36. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med. 2014;11:e1001624.

    PubMed  PubMed Central  Google Scholar 

  37. Wolf E, Rich NE, Marrero JA, Parikh N, Singal AG. Utilization of hepatocellular carcinoma surveillance in patients with cirrhosis: a systematic review and meta-analysis. Hepatology. 2020. https://doi.org/10.1002/hep.31309.

  38. Singal AG, Yopp A, Skinner CS, et al. Utilization of hepatocellular carcinoma surveillance among American patients: a systematic review. J Gen Intern Med. 2012;27:861–7.

    PubMed  PubMed Central  Google Scholar 

  39. Singal AG, Tiro J, Li X, Adams-Huet B, Chubak J. Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system. J Clin Gastroenterol. 2017;51:650–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Warren Andersen S, Blot WJ, Lipworth L, Steinwandel M, Murff HJ, Zheng W. Association of race and socioeconomic status with colorectal cancer screening, colorectal cancer risk, and mortality in Southern US adults. JAMA Netw Open. 2019;2:e1917995.

    PubMed  PubMed Central  Google Scholar 

  41. Singal AG, Li X, Tiro J, et al. Racial, social, and clinical determinants of hepatocellular carcinoma surveillance. Am J Med. 2015;128:90.e1–7.

    Google Scholar 

  42. Farvardin S, Patel J, Khambaty M, Yerokun OA, Mok H, Tiro JA, et al. Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis. Hepatology. 2017;65:875–84.

    PubMed  Google Scholar 

  43. Llovet JM, Fuster J, Bruix J. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10:S115–20.

    PubMed  Google Scholar 

  44. Momin BR, Pinheiro PS, Carreira H, Li C, Weir HK. Liver cancer survival in the United States by race and stage (2001-2009): findings from the CONCORD-2 study. Cancer. 2017;123(Suppl 24):5059–78.

    PubMed  PubMed Central  Google Scholar 

  45. Ha J, Yan M, Aguilar M, Tana M, Liu B, Frenette CT, et al. Race/ethnicity-specific disparities in hepatocellular carcinoma stage at diagnosis and its impact on receipt of curative therapies. J Clin Gastroenterol. 2016;50:423–30.

    PubMed  Google Scholar 

  46. •• Rich NE, Hester C, Odewole M, et al. Racial and ethnic differences in presentation and outcomes of hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2019;17:551–559 e1 Large cohort studt conducted at two urban health systems demonstrating Black patients with HCC suffer worse outcomes compared to non-Hispanic Black and non-Hispanic White counterparts.

    PubMed  Google Scholar 

  47. Jones PD, Diaz C, Wang D, et al. The impact of race on survival after hepatocellular carcinoma in a diverse American population. Dig Dis Sci. 2018;63:515–28.

    PubMed  Google Scholar 

  48. Davila JA, Morgan RO, Richardson PA, du XL, McGlynn KA, el-Serag HB. Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology. 2010;52:132–41.

    PubMed  Google Scholar 

  49. Tan D, Yopp A, Beg MS, Gopal P, Singal AG. Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States. Aliment Pharmacol Ther. 2013;38:703–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Shah SA, Smith JK, Li Y, Ng SC, Carroll JE, Tseng JF. Underutilization of therapy for hepatocellular carcinoma in the medicare population. Cancer. 2011;117:1019–26.

    PubMed  Google Scholar 

  51. Yu JC, Neugut AI, Wang S, Jacobson JS, Ferrante L, Khungar V, et al. Racial and insurance disparities in the receipt of transplant among patients with hepatocellular carcinoma. Cancer. 2010;116:1801–9.

    PubMed  PubMed Central  Google Scholar 

  52. Sonnenday CJ, Dimick JB, Schulick RD, Choti MA. Racial and geographic disparities in the utilization of surgical therapy for hepatocellular carcinoma. J Gastrointest Surg. 2007;11:1636–46.

    PubMed  Google Scholar 

  53. Sobotka LA, Hinton A, Conteh LF. African Americans are less likely to receive curative treatment for hepatocellular carcinoma. World J Hepatol. 2018;10:849–55.

    PubMed  PubMed Central  Google Scholar 

  54. • Rich NE, Hester C, Odewole M, et al. Racial and ethnic differences in presentation and outcomes of hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2019;17:551–559.e1 Recent large, multicenter strudy demonstrating racial disparities in liver transplant for HCC.

    PubMed  Google Scholar 

  55. Dakhoul L, Gawrieh S, Jones KR, Ghabril M, McShane C, Orman E, et al. Racial disparities in liver transplantation for hepatocellular carcinoma are not explained by differences in comorbidities, liver disease severity, or tumor burden. Hepatol Commun. 2019;3:52–62.

    PubMed  Google Scholar 

  56. Mathur AK, Schaubel DE, Gong Q, Guidinger MK, Merion RM. Racial and ethnic disparities in access to liver transplantation. Liver Transpl. 2010;16:1033–40.

    PubMed  PubMed Central  Google Scholar 

  57. Alawadi ZM, Phatak UR, Kao LS, Ko TC, Wray CJ. Race not rural residency is predictive of surgical treatment for hepatocellular carcinoma: analysis of the Texas Cancer Registry. J Surg Oncol. 2016;113:84–8.

    PubMed  Google Scholar 

  58. Stewart SL, Kwong SL, Bowlus CL, Nguyen TT, Maxwell AE, Bastani R, et al. Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012. World J Gastroenterol. 2016;22:8584–95.

    PubMed  PubMed Central  Google Scholar 

  59. Cauble S, Abbas A, Balart L, Bazzano L, Medvedev S, Shores N. United States women receive more curative treatment for hepatocellular carcinoma than men. Dig Dis Sci. 2013;58:2817–25.

    PubMed  Google Scholar 

  60. Yang D, Hanna DL, Usher J, LoCoco J, Chaudhari P, Lenz HJ, et al. Impact of sex on the survival of patients with hepatocellular carcinoma: a surveillance, epidemiology, and end results analysis. Cancer. 2014;120:3707–16.

    PubMed  Google Scholar 

  61. Sobotka L, Hinton A, Conteh L. Women receive more inpatient resections and ablations for hepatocellular carcinoma than men. World J Hepatol. 2017;9:1346–51.

    PubMed  PubMed Central  Google Scholar 

  62. Sarkar M, Watt KD, Terrault N, et al. Outcomes in liver transplantation: does sex matter? J Hepatol. 2015;62:946–55.

    PubMed  Google Scholar 

  63. Mathur AK, Schaubel DE, Gong Q, Guidinger MK, Merion RM. Sex-based disparities in liver transplant rates in the United States. Am J Transplant. 2011;11:1435–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Halbert CH, Weathers B, Delmoor E, Mahler B, Coyne J, Thompson HS, et al. Racial differences in medical mistrust among men diagnosed with prostate cancer. Cancer. 2009;115:2553–61.

    PubMed  PubMed Central  Google Scholar 

  65. Karliner LS, Hwang ES, Nickleach D, Kaplan CP. Language barriers and patient-centered breast cancer care. Patient Educ Couns. 2011;84:223–8.

    PubMed  Google Scholar 

  66. Abbott DE, Voils CL, Fisher DA, Greenberg CC, Safdar N. Socioeconomic disparities, financial toxicity, and opportunities for enhanced system efficiencies for patients with cancer. J Surg Oncol. 2017;115:250–6.

    PubMed  Google Scholar 

  67. Mokdad AA, Murphy CC, Pruitt SL, Mansour JC, Marrero JA, Singal AG, et al. Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma. Cancer. 2018;124:743–51.

    PubMed  Google Scholar 

  68. Hoehn RS, Hanseman DJ, Dhar VK, et al. Opportunities to improve care of hepatocellular carcinoma in vulnerable patient populations. J Am Coll Surg. 2017;224:697–704.

    PubMed  Google Scholar 

  69. Wang J, Ha J, Lopez A, Bhuket T, Liu B, Wong RJ. Medicaid and uninsured hepatocellular carcinoma patients have more advanced tumor stage and are less likely to receive treatment. J Clin Gastroenterol. 2018;52:437–43.

    PubMed  Google Scholar 

  70. Rogers SO, Ray WA, Smalley WE. A population-based study of survival among elderly persons diagnosed with colorectal cancer: does race matter if all are insured? (United States). Cancer Causes Control. 2004;15:193–9.

    PubMed  Google Scholar 

  71. Zeng C, Wen W, Morgans AK, Pao W, Shu XO, Zheng W. Disparities by race, age, and sex in the improvement of survival for major cancers: results from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program in the United States, 1990 to 2010. JAMA Oncol. 2015;1:88–96.

    PubMed  PubMed Central  Google Scholar 

  72. Hester CA, Karbhari N, Rich NE, Augustine M, Mansour JC, Polanco PM, et al. Effect of fragmentation of cancer care on treatment use and survival in hepatocellular carcinoma. Cancer. 2019;125:3428–36.

    PubMed  Google Scholar 

  73. Artinyan A, Mailey B, Sanchez-Luege N, et al. Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States. Cancer. 2010;116:1367–77.

    PubMed  Google Scholar 

  74. Mathur AK, Osborne NH, Lynch RJ, et al. Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma. Arch Surg. 2010;145:1158–63.

    PubMed  Google Scholar 

  75. Njei B, Ditah I, Lim JK. Persistent racial disparities in survival among US adults with hepatocellular carcinoma after liver transplantation: the paradox of all-cause and cause-specific mortality. Gastrointest Cancer Res. 2013;6:73–4.

    PubMed  PubMed Central  Google Scholar 

  76. Cook MB, McGlynn KA, Devesa SS, et al. Sex disparities in cancer mortality and survival. Cancer Epidemiol Biomark Prev. 2011;20:1629–37.

    Google Scholar 

  77. Rich NE, John BV, Parikh ND, Rowe I, Mehta N, Khatri G, et al. Hepatocellular carcinoma demonstrates heterogeneous growth patterns in a multi-center cohort of patients with cirrhosis. Hepatology. 2020. https://doi.org/10.1002/hep.31159.

  78. Nathani P, Gopal P, Rich N, Yopp A, Yokoo T, John B, et al. Hepatocellular carcinoma tumour volume doubling time: a systematic review and meta-analysis. Gut. 2020. https://doi.org/10.1136/gutjnl-2020-321040.

  79. Williams DR, Kontos EZ, Viswanath K, Haas JS, Lathan CS, MacConaill LE, et al. Integrating multiple social statuses in health disparities research: the case of lung cancer. Health Serv Res. 2012;47:1255–77.

    PubMed  PubMed Central  Google Scholar 

  80. •• Alcaraz KI, Wiedt TL, Daniels EC, et al. Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA Cancer J Clin. 2020;70:31–46 Provides a framework to improve our understanding of social determinants of health to improve health equity for all patients with cancer; presents actionable recommendations for research helath policy.

    PubMed  Google Scholar 

  81. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10:e0138511.

    PubMed  PubMed Central  Google Scholar 

  82. Penner LA, Dovidio JF, Gonzalez R, Albrecht TL, Chapman R, Foster T, et al. The effects of oncologist implicit racial bias in racially discordant oncology interactions. J Clin Oncol. 2016;34:2874–80.

    PubMed  PubMed Central  Google Scholar 

  83. Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366:447–53.

    CAS  PubMed  Google Scholar 

  84. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. N Engl J Med. 2020;383:874–82.

    PubMed  Google Scholar 

  85. Levey AS, Tighiouart H, Titan SM, Inker LA. Estimation of glomerular filtration rate with vs without including patient race. JAMA Intern Med. 2020;180:793–5.

    PubMed  Google Scholar 

  86. • Verna EC, Lai JC. Time for action to address the persistent sex-based disparity in liver transplant access. JAMA Surg. 2020;155:545–7 Timely editorial on the need to reduce disparities in access to life-saving treatments for patients with advanced liver disease and HCC, such as liver transplantation.

    PubMed  Google Scholar 

  87. Locke JE, Shelton BA, Olthoff KM, Pomfret EA, Forde KA, Sawinski D, et al. Quantifying sex-based disparities in liver allocation. JAMA Surg. 2020;155:e201129.

    PubMed  Google Scholar 

Download references

Funding

Drs. Singal and Rich are supported by National Cancer Institute R01 MD12565. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, 5959 Harry Hines Blvd, POB 1, Suite 420, Dallas, TX, 75390-8887, USA

    Faith Ajayi, Jenny Jan, Amit G. Singal & Nicole E. Rich

  2. Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA

    Amit G. Singal & Nicole E. Rich

  3. Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA

    Amit G. Singal

Authors
  1. Faith Ajayi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jenny Jan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit G. Singal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicole E. Rich
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: all authors; drafting of the manuscript: all authors; critical revision of the manuscript for important intellectual content: all authors.

Corresponding author

Correspondence to Nicole E. Rich.

Ethics declarations

Conflict of Interest

Amit Singal has been on advisory boards and served as a consultant for Wako Diagnostics, Roche, Exact Sciences, Glycotest, Bayer, Eisai, Exelixis, BMS, Merck Genentech, and TARGET-Pharmasolutions. The other authors have no relevant conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Hepatic Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ajayi, F., Jan, J., Singal, A.G. et al. Racial and Sex Disparities in Hepatocellular Carcinoma in the USA. Curr Hepatology Rep 19, 462–469 (2020). https://doi.org/10.1007/s11901-020-00554-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-020-00554-6

Keywords

Search

Navigation