P2852 - Association Between Neighborhood Opportunity and Guideline Concordant Hepatocellular Carcinoma Surveillance

Erin Bouquet, MD¹, Joanna Jiang, MD¹, Bipul Gnyawali, BS, MD², Dayssy A.. Diaz, MD, MS³, Lanla F. Conteh, MD, MBA, MPH², Mohamed I. Elsaid, PhD, MPH⁴, Lindsay A. Sobotka, DO^1
1The Ohio State Wexner Medical Center, Columbus, OH; ²The Ohio State University Wexner Medical Center, Columbus, OH; ³Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH; ⁴The Ohio State University, Columbus, OH

Introduction: Social disparities are prevalent in cancer screening adherence. The 2014-2018 Ohio Opportunity Index (OOI) is a multidimensional tool to quantify neighborhood-level opportunity. A high score – derived from variables including local transportation, education, employment, health, housing, crime, and environment – reflects greater resources while a low score conveys increased risk due to diminished resources. The association between OOI and HCC screening was studied.

Methods: This observational retrospective study evaluated patients with cirrhosis and HCC who received care at The Ohio State University Wexner Medical Center between 1/1/2015 and 12/31/2021. Modified Poisson regression models with robust variance adjusted for demographics, cirrhosis etiology, hepatic decompensation features, and the Model for End-Stage Liver Disease-Sodium (MELD-Na) score to examine the associations, on the prevalence ratio (aPR) scale, between guideline-concordant HCC screening (defined as completion of abdominal imaging every 6 months) and high neighborhood opportunity status. A high opportunity was defined as scores greater than the cohort’s third quartile.

Results: The study included 157 patients with cirrhosis and HCC. Patient demographics included an average age of 66.3 years, 23.6% female, 18.5% Caucasian, 52.9% were married, 66.2% had Medicare, and 67.5% were unemployed or retired. This most common etiology of cirrhosis was viral hepatitis C and alcohol and the average MELD-Na score was 10. Patients with high OOI were more likely to follow up with a hepatology provider before diagnosis of HCC than those with low OOI (32.5% vs. 10.3%, p=0.0009). Only 25.5% of patients with cirrhosis had guideline-concordant HCC screening. The prevalence of guideline-concordant HCC screening was significantly higher amongst patients with high vs. low OOI (45.0% vs. 18.8%, p=0.0001), prevalence difference of 26.2% (95% CI: 9.8% to 42.6%). The adjusted prevalence ratio of guideline-concordant HCC screening was significantly higher in patients with high vs low OOI (aPR 2.25,95% CI: 1.26 to 3.99).

Discussion: There is a significant difference in guideline-concordant HCC screening between patients with high vs. low OOI, even when controlled for clinical and demographic variables. Consideration to socioeconomic contextual factors can assist clinicians, particularly non-hepatology providers, in identifying vulnerable populations to enhance HCC screening and early detection.


Disclosures:


Erin Bouquet, MD¹, Joanna Jiang, MD¹, Bipul Gnyawali, BS, MD², Dayssy A.. Diaz, MD, MS³, Lanla F. Conteh, MD, MBA, MPH², Mohamed I. Elsaid, PhD, MPH⁴, Lindsay A. Sobotka, DO¹. P2852 - Association Between Neighborhood Opportunity and Guideline Concordant Hepatocellular Carcinoma Surveillance, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.