North Carolina medical journal · 2025
Patient-, Provider-, and Area-Level Factors Associated with Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis in North Carolina.
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Hsu Christine D, Henderson Louise M, Jackson Bradford E, Baggett Christopher D, Johnson Funk Michele, Olshan Andrew F, Gupta Parul, Barritt A Sidney, Sanoff Hanna K, Wheeler Stephanie B, Lund Jennifer L, Moon Andrew M
Аннотация
BACKGROUND: Clinical guidelines recommend hepatocellular carcinoma (HCC) surveillance with an abdominal ultrasound every 6 months for individuals with cirrhosis. However, surveillance uptake is low, and few studies have examined factors associated with surveillance uptake using large, contemporary cohorts.
METHODS: Using claims data from Medicare, Medicaid, and private plans in North Carolina, we conducted a retrospective cohort study including individuals aged 18 years old and older with a first claims-based cirrhosis diagnosis between January 1, 2010, and June 30, 2018, with at least 12 months of continuous insurance enrollment before the cirrhosis diagnosis. A subdistribution hazard model was used to assess associations between patient-, provider-, and area-level factors and 2-year cumulative incidence of HCC surveillance.
RESULTS: Among 46,052 individuals with cirrhosis, 54.7% received a first HCC surveillance exam within 2 years after the cirrhosis diagnosis. Those with non-viral cirrhosis etiologies had lower surveillance uptake than individuals with viral hepatitis. Subdistribution hazard ratios were higher for those with Medicare versus Medicaid, for those with decompensated versus compensated cirrhosis, and for those with gastroenterology/hepatology care in the year before their cirrhosis diagnosis versus those without specialty care.
LIMITATIONS: Potentially important barriers to HCC surveillance, such as cost- and transportation-related factors, were not included or directly ascertained in the analyses, as they were not available in the claims data.
CONCLUSIONS: Individuals with non-viral cirrhosis etiologies, Medicare insurance, decompensated cirrhosis, and gastroenterology care in the year before the index date were more likely to receive an HCC surveillance exam in the 2 years after their cirrhosis diagnosis than their counterparts. Findings from this study may serve as a benchmark to measure state-level progress in increasing HCC surveillance and help identify subgroups to target for future interventions.
METHODS: Using claims data from Medicare, Medicaid, and private plans in North Carolina, we conducted a retrospective cohort study including individuals aged 18 years old and older with a first claims-based cirrhosis diagnosis between January 1, 2010, and June 30, 2018, with at least 12 months of continuous insurance enrollment before the cirrhosis diagnosis. A subdistribution hazard model was used to assess associations between patient-, provider-, and area-level factors and 2-year cumulative incidence of HCC surveillance.
RESULTS: Among 46,052 individuals with cirrhosis, 54.7% received a first HCC surveillance exam within 2 years after the cirrhosis diagnosis. Those with non-viral cirrhosis etiologies had lower surveillance uptake than individuals with viral hepatitis. Subdistribution hazard ratios were higher for those with Medicare versus Medicaid, for those with decompensated versus compensated cirrhosis, and for those with gastroenterology/hepatology care in the year before their cirrhosis diagnosis versus those without specialty care.
LIMITATIONS: Potentially important barriers to HCC surveillance, such as cost- and transportation-related factors, were not included or directly ascertained in the analyses, as they were not available in the claims data.
CONCLUSIONS: Individuals with non-viral cirrhosis etiologies, Medicare insurance, decompensated cirrhosis, and gastroenterology care in the year before the index date were more likely to receive an HCC surveillance exam in the 2 years after their cirrhosis diagnosis than their counterparts. Findings from this study may serve as a benchmark to measure state-level progress in increasing HCC surveillance and help identify subgroups to target for future interventions.