Background: To investigate the impact of socioeconomic factors on overall survival (OS) for patients with hepatocellular carcinoma (HCC) at an inner-city tertiary care hospital. Methods: Consecutive patients treated for HCC diagnosed between 2005 and 2016 in the cancer registry were studied. Patients were stratified by demographic, socioeconomic variables and treatment course. Kaplan-Meier curves and Cox proportional hazard modeling were performed. Results: Patients were 79% male (770 pts) with mean age of 62.8 yrs (SD 10.2 yrs). 25% of patients (239 pts) had private insurance, 38% (363 pts) with Medicare, and 34% (239 pts) with Medicaid. Median OS stratified by primary insurance demonstrated a survival benefit for private insurance with 27.8 mo (95% CI 23.1–33.1) vs 21.0 mo (95% CI 16.5–26.5) for Medicare (HR 0.82, p = 0.0344) vs 13.3 mo (95% CI 10.2–19.7) for Medicaid (HR 0.80, p = 0.0002) (p = 0.0007). When further stratified by AJCC Stage, median OS in Stage II was 55.3 mo (95% CI: 32.4–67.1 mo) for private insurance vs 26.0 mo (95% CI: 18.7–36.3 mo) in Medicare vs 13.2 mo (95% CI: 9.0–38.1 mo) in Medicaid (p = 0.0309). Private insurance in Stage III had a median OS of 23.8 mo (95% CI: 10.9–39.8 mo) vs 14.6 mo (95% CI: 7.5–30.8 mo) in Medicare vs 6.7 mo in Medicaid (95% CI: 2.5–12.2 mo) (p = 0.0069). No differences were seen in Stage I and Stage IV. Cancer-directed treatments were utilized in 91% of private insurance vs 84% in Medicare vs 78% in Medicaid (p < 0.0001). Median OS stratified by marital status showed 23.7 mo (95% CI: 21.0–28.1 mo) for married (720 pts, 76%) vs 5.2 mo (95% CI: 9.6–20.1 mo) for never-married (227 pts, 24%) (p = 0.0009) (HR 1.4, p = 0.0013). Cancer-directed treatments were utilized by 87% of married vs 77% of never-married (p = 0.0016). Increased age was associated with decreased median OS (correlation -0.14, p < 0.0001). No differences in OS were seen with ethnicity or gender. Multivariate Cox proportional analysis demonstrated survival advantage for private insurance versus Medicaid (HR 1.3, p = 0.0435) and Medicare (HR 1.2, p = 0.0472). Conclusions: Primary insurance and social support appear to affect the OS of patients with HCC. Further investigations to elucidate the socioeconomic determinants to enhance survivals are warranted.