Disparities Found in Liver Cancer Surveillance Participation for Patients With Disabilities

Significant disparities exist in liver cancer surveillance participation for patients with severe physical disabilities and brain-related or mental disabilities, according to a study in the Journal of Clinical Gastroenterology.

The findings are based on data from the National Health Information Research Database (NHIRD) in Korea from 2006 to 2015. Investigators linked data regarding national disability registration with national cancer surveillance data. They then analyzed age-standardized participation rates for each year during the study period according to presence, type, and severity of disability. They also conducted multivariate logistic regression to assess factors associated with liver cancer surveillance using the most current data, from 2014 to 2015.

The number of persons eligible for liver cancer surveillance increased from 605,517 in 2006 to 1,046,343 in 2015. The number of eligible persons with and without a disability were 563,668 and 41,849 in 2006, respectively, and increased to 937,636 and 108,707 in 2015, respectively. In addition, the proportion of persons with disabilities compared with those without increased from 7.4% in 2006 to 11.6% in 2015.

Age- and sex-adjusted rates for liver cancer surveillance in patients with disabilities increased from 25.7% in 2006 to 49.6% in 2015, and surveillance rates for persons without disabilities increased from 24.9% to 54.5% during this period. Patients with mild disabilities had a greater increase in surveillance rates (27.7% to 52.9%), compared against those with severe disabilities (20.8% to 44.1%).

After the investigators adjusted surveillance rates by age, income level, place of residence, and calendar year, they found that disability was associated with a 12% lower liver cancer surveillance rate (adjusted odds ratio [aOR] = 0.88; 95% CI, 0.87-0.89). Patients with severe disabilities had lower surveillance rates compared against those without disabilities (aOR = 0.71; 95% CI, 0.70-0.72).

Among other findings, patients who had an intellectual disability (aOR = 0.69; 95% CI, 0.66-0.73) and those with a disability due to ostomy (aOR = 0.60; 95% CI, 0.53-0.68), brain injury (aOR = 0.60; 95% CI, 0.58-0.62), renal disease (aOR = 0.43; 95% CI, 0.41-0.45), or liver disease (aOR = 0.42; 95% CI, 0.40-0.44) had relatively lower rates of liver cancer surveillance compared against persons without disabilities.

Potential explanations for the cancer surveillance disparity associated with disability status include low patient awareness of recommendations or misconceptions about surveillance, physical access barriers, surveillance test expenses, and health care providers’ lack of knowledge regarding disabilities and negative stereotyping.

Among several study limitations, the researchers did not consider clinical or demographic variables that may affect liver cancer surveillance participation or opportunistic surveillance. In addition, they could not assess the reasons for nonparticipation in liver cancer surveillance among patients with disabilities.

“Policies should be directed toward identifying and removing the barriers to liver cancer surveillance in people with disabilities,” the study authors concluded.

Reference

Seo JY, Shin DW, Yu SJ, et al. Disparities in liver cancer surveillance among people with disabilities: a national database study in Korea. J Clin Gastroenterol. 2021;55(5):439-448.