Dissecting Disease, Race, Ethnicity, And Socioeconomic Factors For Hepatocellular Carcinoma: An Analysis From The United States Safety Net Collaborative

Purpose Hepatocellular carcinoma (HCC) incidence rates have been increasing in the United States for the past 35 years. Because HCC has a poor prognosis, quantitative forecasts could help to inform prevention and treatment strategies to reduce the incidence and burden of HCC. Methods Single-year HCC incident case and population data for the years 2000 to 2012 and ages 35 to 84 years were obtained from the SEER 18 Registry Database. We forecast incident HCC cases through 2030, using novel age-period-cohort models and stratifying by sex, race/ethnicity, and age. Rates are presented because absolute numbers may be influenced by population increases. Results Rates of HCC increased with each successive birth cohort through 1959. However, rates began to decrease with the 1960 to 1969 birth cohorts. Asians/Pacific Islanders (APIs) have had the highest HCC rates in the United States for many years, but the rates have stabilized and begun to decline in recent years. Between 2013 and 2030, rates among APIs are forecast to decline further, with estimated annual percentage changes of −1.59% among men and −2.20% among women. Thus, by 2030, Asians are forecast to have the lowest incidence rates among men, and Hispanics are forecast to have the highest rates among men (age-standardized rate, 44.2). Blacks are forecast to have the highest rate among women (age-standardized rate, 12.82). Conclusion Although liver cancer has long had some of the most rapidly increasing incidence rates, the decreasing rates seen among APIs, individuals younger than 65 years, and cohorts born after 1960 suggest that there will be declines in incidence of HCC in future years. Prevention efforts should be focused on individuals in the 1950 to 1959 birth cohorts, Hispanics, and blacks.

Download Full-text

Associations of Race/Ethnicity and Other Demographic and Socioeconomic Factors with Vaccination During the COVID-19 Pandemic in the United States

10.1101/2021.02.16.21251769 ◽

2021 ◽

Author(s):

Daniel Kim

Keyword(s):

United States ◽

Socioeconomic Factors ◽

Vaccine Dose ◽

The United States ◽

Adverse Outcomes ◽

Vaccine Hesitancy ◽

Vaccine Initiation ◽

Race Ethnicity ◽

Nationally Representative ◽

Socioeconomic Data

AbstractBACKGROUNDTo date, there has been limited data available to understand the associations between race/ethnicity and socioeconomic and related characteristics with COVID-19 vaccine initiation and planned vaccination in the United States. To better characterize COVID-19 vaccinations nationally, the present study leveraged nationally-representative data with relatively complete race/ethnicity and socioeconomic data to estimate levels of vaccine initiation and the adjusted relative odds of vaccine initiation and planned vaccination among adults by race/ethnicity and socioeconomic and other characteristics.METHODSUsing pooled cross-sectional data from 66,994 adults aged 18-85 years in nationally-representative surveys by the U.S. Census Bureau administered between January 6, 2021 and January 18, 2021 and multivariable logistic regression, this study estimated the associations between race/ethnicity, education, and pre-pandemic (2019) household income with the self-reported: 1) receipt of ≥1 dose of a COVID-19 vaccine; and 2) either receipt of ≥1 dose of a COVID-19 vaccine or the plan to definitely receive a vaccine once available to the respondent.RESULTSIn Hispanics and Black non-Hispanics, the estimated prevalences of vaccine initiation were 6.1% and 6.2%, respectively, compared to 8.7% in White non-Hispanics and 15.1% in Asian non-Hispanics. Controlling for demographic and socioeconomic factors, Hispanics and Black non-Hispanics were no more or less likely than White non-Hispanics to have received ≥1 vaccine dose. However, for the combined outcome of either vaccine initiation or planned vaccination, Black non-Hispanics were 52% less likely than White non-Hispanics to have reported either outcome (P<.001). Meanwhile, both education and pre-pandemic income levels exhibited evidence of positive dose-response relationships with vaccine initiation (P for linear trend = .01 and <.001, respectively). Substantial (vs. no) financial hardship was linked to 44% lower odds of vaccination (P<.001). The most common reasons for vaccine hesitancy were concerns about side effects and safety.CONCLUSIONSIn this large, nationally-representative study with relatively complete race/ethnicity and socioeconomic data, we find that being Black non-Hispanic and having the least education and income were each independently associated with a markedly lower likelihood of definitely planning to get vaccinated or having been vaccinated. In the ensuing months of the pandemic, addressing racial/ethnic and socioeconomic inequities in vaccination due to differential access and vaccine hesitancy will be critical to mitigate the pandemic’s disproportionately higher risks of infection and adverse outcomes in Black non-Hispanics and socioeconomically disadvantaged groups and to help maximize vaccination coverage nationwide.

Download Full-text