Table 1 Summary of new studies addressing health inequalities in HCC in the UK, grouped by study design and ordered by year of publication (most recent first).
Study | Design | Cohort and Setting | Period | Dimensions of Care | Axes of Health Inequality | Findings | Implications |
|---|---|---|---|---|---|---|---|
Liao et al., 2023 [12] | Retrospective cohort study | 7,331 PLC cases in England from QResearch Primary Care Database | 2008–2018 | Diagnosis Treatment Survival | Age Deprivation level Ethnicity Sex | Age, sex, deprivation, ethnicity, and regions associated with higher incidence, late diagnosis, emergency presentation. Older age emergency presentation and lower treatment rates. | Complex public health approach recommended. Research on early detection is key. |
Hamill et al., 2023 [25] | Retrospective cohort study | 1,908 cases of cirrhosis with cured HCV across the UK from linked Hepatitis C Research UK resource and diagnostic imaging dataset | 2012–2015 | Surveillance | Accessing services Age Region | Inefficient ( > 10000 scans to treat 49 cases curatively). Low adherence 19% in first 3 years post SVR then 9% for all follow-up. Higher uptake associated with transplant centre and older age. | Surveillance poorly targeted, inefficient, and inequitable. Need for standardisation and better monitoring at national level. |
Geh et al., 2022 [59] | Retrospective and prospective cohort study single centre | 310 HCC cases in North East and Cumbria, England from regional HPB MDM | 2019–2021 | Surveillance Diagnosis Treatment Survival | Accessing services Aetiology | Covid-19 pandemic resulted in reduced surveillance adherence and HCC detection and increase in symptomatic presentation and larger tumours. Surveillance associated with better survival. | Advice resuming HCC surveillance in line with guidelines. |
Beecroft et al., 2022 [14] | Retrospective nationwide cohort study | 2160 HCC cases across England from national cancer registry and linked data | 2016–2017 | Treatment Survival | Aetiology Region | Majority (58.4%) untreated, low curative treatment (24.4%), ARLD lower treatment rates. Survival low. Variation in outcomes in regions with similar incident rates. London appears to be an outlier. | Deeper exploration of regional treatments and screening practices are needed. Lack of national data on cancer stage at diagnosis. |
Farrell et al., 2017 [24] | Retrospective cohort study single centre | 804 patients receiving HCC surveillance at Royal Liverpool Hospital identified from radiology requests | 2009–2013 | Surveillance Treatment Survival | Accessing services Aetiology | Low adherence 45%. Suboptimal performance of radiology-led recall system. Surveillance associated with improved survival. | Barriers to surveillance and discontinuation reasons need to be identified. High-quality studies of current surveillance practice required. |
Selvapatt et al., 2016 [47] | Retrospective cohort study single centre | 898 cases of cirrhosis eligible for surveillance at Imperial College Healthcare NHS Trust | 2013–2014 | Surveillance Diagnosis Treatment Survival | Accessing services Age Sex Region | Reasons for overdue surveillance presented. No significance between characteristics and adherence / adherence and outcomes. | Limited by 6-month study period. Basic patient (DNA), system and clinical reasons for non-adherence / discontinuation presented. |
Haq et al., 2021 [44] | Real-world prospective longitudinal study | 985 HCC cases across Glasgow and Edinburgh, Scotland from regional HPB MDMs | 2009–2015 | Surveillance Diagnosis Treatment Survival | Accessing services Aetiology Age Sex | 60% symptomatic diagnosis. 76% adherence for those in surveillance. Younger age, females, ARLD, viral and MASLD associated with surveillance. Adherence associated with earlier stage, curative treatment, and improved survival after accounting for lead time bias. | Adherence is critical for effectiveness. Poor adherence similar outcomes to no surveillance. Pragmatic definition of adherence – ultrasound within 9 months of HCC diagnosis. |
Smittenaar et al., 2016 [2] | PLC incidence and mortality projections using an age-period-cohort model with natural cubic splines | N/A | 1974–2014 UK data used to estimate 2015–2035 projections | Diagnosis Survival | Age Sex | PLC projected to have the highest average annual increase of all cancers in the UK over the next 15 years. Increasing PLC mortality | Greater efforts required to tackle risk factors. Planning for increasing burden of cancer is needed. Possible artefactual increase in mortality as poor concordance with PLC diagnosis and death certificate information. Liver is common site of secondary metastases. |
Burton et al., 2022 [13] | Retrospective population-based nationwide analysis | 15,468 HCC cases across England from national cancer registry and linked data | 2010–2016 | Diagnosis Treatment Survival | Age Deprivation level Sex Region | Highest incidence in North and London. Increasing deprivation and age associated with emergency presentation and less curative treatment. | Identified regions requiring additional resources. |
Burton et al., 2021 [1] | Retrospective population-based nationwide analysis | 82,024 PLC cases across the UK From national cancer registries | 1997–2017 | Diagnosis Survival | Gender Region | Higher incidence in men. Highest incidence and mortality in Scottish men. No difference in survival between genders. | Improvements in survival for HCC, although increasing risk from obesity, diabetes and alcohol excess a public health concern. |
Webb et al., 2019 [23] | National registry analysis | 11,188 UK listings for liver transplant (8490 transplanted) | 1995–2014 | Treatment Survival | Accessing services Aetiology Age Sex Region | Increasing travel time associated with increased death after listing, and reduced likelihood of transplantation or recovery. | Inequitable accessibility of liver transplantation. Bristol is suggested as optimum site for an additional UK transplant centre to mitigate effect of travel time. |
Konfortion et al., 2014 [27] | Retrospective population-based nationwide analysis | 40,945 cases PLC in England from National Cancer Data Repository | 1990–2009 | Diagnosis | Deprivation level Sex | Increasing incidence of PLC in both sexes, largely driven by increasing HCC in men from most deprived quintile. | Rising incidence may be due to variation in known risk factors. |
Ladep et al., 2014 [28] | Retrospective population-based nationwide analysis | PLC cases in England and Wales from National Cancer Data Repository | 1968–2008 | Diagnosis Survival | Ethnicity Sex | Rising incidence and mortality from PLC. Particularly HCC in men. Higher in migrants from high incident countries. Histology increasing mode of diagnosis. | Increasing use of histology for diagnosis may be increasing case ascertainment. |
Jack et al., 2013 [29] | Retrospective population-based nationwide analysis | 17,458 PLC cases in England from national cancer registry | 2001–2007 | Diagnosis Survival | Age Deprivation level Ethnicity Sex | Variations in the incidence and survival of PLC between ethnic groups and deprivation level. Likely due to established risk factors like HBV/HCV prevalence. | Awareness of higher risk groups. Country of birth, age at migration and length of stay in England should be recorded in future research. |
West et al., 2006 [30] | Retrospective population-based nationwide analysis | PLC cases from National Cancer Registries | 1971–2001 | Diagnosis | Age Sex | HCC remains commonest PLC in males. Decreasing incidence in older age groups. | Ongoing burden from HCC in males. Unclear why reducing incidence in elderly. |
Haworth et al., 1999 [31] | Retrospective population-based analysis of first-generation migrants | 10,521 deaths from cirrhosis and 3237 deaths from PLC from mortality data in England and Wales | 1988–1992 | Survival | Ethnicity Sex | Higher mortality from PLC in male migrants from Asia, Africa, Scotland, and Ireland. | Prevention and screening resources could be targeted for certain ethic groups. Screening and benefit/cost ratio requires further research. |
