Background: Despite advances in diagnosis and treatment of hepatocellular carcinoma (HCC), disparities in care utilization and health outcomes persist. Few studies have evaluated the impact of race/ethnicity and socioeconomic status (SES) on incidence of emergency department (ED) visits, which may reflect access to and quality of cancer care. We investigated this relationship among patients (pts) with HCC. Methods: Using 100% Medicare Fee-for-Service claims and a commercial multi-payor claims database, pts diagnosed with HCC between 2014-2018 were identified. Using 9-digit ZIP code from enrollment records, pts were matched to near-neighborhood social determinants of health (SDOH) characteristics, including income, education, English language ability, living alone, vehicle ownership, rurality, and primary care shortages. We defined SES according to income level: low (≤2 times [x] federal poverty level [FPL]), middle (2-3x FPL), and high (>3x FPL). We used generalized linear regressions to evaluate the effect of race/ethnicity on incidence rate ratios (IRR) of ED visits, adjusting for SDOH variables and demographic and clinical characteristics. We further stratified ED IRR by income level to examine how racial/ethnic differences in ED visits differ by SES. Results: 22,247 pts with HCC were identified (median age 69; 63% male; 69% White, 14% Black, 7% Hispanic, 6% Asian, 4% Other). The table summarizes adjusted IRR of ED visits for each racial/ethnic group compared with whites, overall and by income level. Overall, ED visits were higher for Blacks (IRR 1.27) and Hispanics (IRR 1.17) and lower for Asians (IRR 0.67). When stratified by income, Blacks and Hispanics had larger incidence of ED visits compared with Whites at higher income levels; these differences became insignificant at low income level. Asians had lower rate of ED visits regardless of income. Conclusions: Black and Hispanic pts with HCC demonstrated higher rates of ED visits compared with Whites. These differences were more pronounced at higher income levels, particularly for Blacks, suggesting racial disparities may differ by SES. Further research is needed to understand the intersectionality between race/ethnicity, SES and other SDOH, to guide structural-level interventions to address these disparities.

¹Adjusted for other SDOH variables, age, gender, payer type, region, Charlson Comorbidity score, treatment type ²vs. White (reference) * p <.05 ** p <.0001.