Hepatocellular carcinoma amongst Aboriginal and Torres Strait Islander peoples of Australia
Files
(Published version)
Date
2021
Authors
Wigg, A.J.
Narayana, S.K.
Hartel, G.
Medlin, L.
Pratt, G.
Powell, E.E.
Clark, P.
Davies, J.
Campbell, K.
Toombs, M.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
EClinicalMedicine, 2021; 36:100919-1-100919-9
Statement of Responsibility
Alan J Wigg, Sumudu K Narayana, Gunter Hartel, Linda Medlin, Greg Pratt, Elizabeth E. Powell, Paul Clark, Jane Davies, Kirsty Campbell, Maree Toombs, Michael Larkin, Patricia C Valery
Conference Name
Abstract
Background: Liver disease and hepatocellular carcinoma (HCC) are important contributors to the mortality gap between Indigenous and non-Indigenous Australians. However, there is a lack of population based high quality data assessing the differences in HCC epidemiology and outcomes according to Indigenous status. The aim of this study was therefore to perform a large epidemiological study of HCC investigating differences between Indigenous and non-Indigenous Australians with HCC. Methods: Study design was a retrospective cohort study. Data linkage methodology was used to link data from cancer registries with hospital separation summaries across three Australian jurisdictions during 20 0 0–2017. Cumulative survival (Kaplan-Meier) and the differences in survival (Multivariable Cox- regression) by Indigenous status were assessed. Findings: A total of 229 Indigenous and 3587 non-Indigenous HCC cases were included in the analyses. Significant epidemiological differences identified for Indigenous HCC cases included younger age at onset, higher proportion of females, higher rurality, lower socioeconomic status, and higher comorbidity burden (all p < 0.001). The distribution of cofactors was also significantly different for Indigenous Australians including higher prevalence of alcohol misuse, hepatitis B, and diabetes and more frequent presence of multiple HCC cofactors (all p < 0.001). Indigenous Australians received curative HCC therapies less frequently (6.6% vs. 14.5%, p < 0.001) and had poorer 5-year survival (10.0% vs. 17.3%, p < 0.001; unadjusted hazard ratio (HR) = 1.42 96%CI 1.21–1.65) compared to non-Indigenous Australians. The strength of the association between indigenous status and survival was weaker and statistically non-significant after adjusting for rurality, comorbidity burden and lack of curative therapy (adjusted-HR = 1.20 95%CI 0.97–1.47) Interpretation: Such data provide a call to action to help design and implement health literacy, liver management and HCC surveillance programs for Indigenous people to help close the liver cancer mortality gap. Funding: The work was supported by an unrestricted educational grant from the Gastroenterology Society of Australia. Patricia Valery and Elizabeth Powell were supported by Metro South Health Indigenous Health Research Grants.
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
Crown Copyright © 2021 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)