# Multilevel factors for racial/ethnic and socioeconomic disparities in prognosis of hepatocellular carcinoma

> **NIH NIH R01** · UT SOUTHWESTERN MEDICAL CENTER · 2022 · $93,598

## Abstract

Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related death in the U.S. HCC
disproportionally affects racial/ethnic minority and socioeconomically disadvantaged populations, with higher
age-adjusted mortality observed in non-Hispanic blacks and Hispanic whites than non-Hispanic whites. To
evaluate these disparities, we will use an adapted Warnecke/Centers for Population Health and Health
Disparities ecological multi-level model attributing disparate health outcomes to biological-environmental
interactions between and across distal (population social conditions and policies), intermediate (social and
physical contexts including social relationships), and proximal (individual demographics and biological
responses) determinants. Applying this model to HCC disparities will facilitate identification of key drivers of
disparities in prognosis, which is the first necessary step to develop intervention strategies aimed at improving
survival and reducing disparities following HCC diagnosis. Specifically, our proposal will characterize the
contribution of proximal, intermediate, and distal determinants to disparities in 3 known measures of HCC
prognosis: a) tumor stage at diagnosis, b) receipt of timely and guideline-concordant HCC treatment, and c)
overall survival. Leveraging existing clinical databases and a biorepository of stored serum, we will conduct a
multi-center study using electronic medical record-derived, patient-reported, provider-reported, and serum-
based biological factors in a cohort of ~5000 patients newly diagnosed with HCC over a 13-year period to:
Aim 1: Characterize the contribution of proximal, intermediate, and distal determinants of
racial/ethnic and socioeconomic disparities in HCC tumor stage at diagnosis
Aim 2: Determine racial/ethnic and socioeconomic disparities in receipt of timely and guideline-
concordant HCC treatment including proximal, intermediate, and distal determinants
Aim 3: Identify proximal, intermediate, and distal determinants of racial/ethnic and socioeconomic
disparities in overall survival following HCC diagnosis
Overall, we will identify factors across and within multiple levels associated with disparities in HCC prognosis
between non-Hispanic white, Hispanic white, and non-Hispanic black patients as well as low versus high SES
class in a large, racial/ethnically and socioeconomically diverse diverse cohort of ~5000 HCC patients. Our
study will provide an understanding of why HCC prognosis disparities exist and at what level interventions
should be implemented to reduce disparities improving overall survival.

## Key facts

- **NIH application ID:** 10427946
- **Project number:** 3R01MD012565-05S1
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** Amit Singal
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $93,598
- **Award type:** 3
- **Project period:** 2018-04-03 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10427946

## Citation

> US National Institutes of Health, RePORTER application 10427946, Multilevel factors for racial/ethnic and socioeconomic disparities in prognosis of hepatocellular carcinoma (3R01MD012565-05S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10427946. Licensed CC0.

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