Year of Publication



Public Health

Date Available


Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Dr. Wayne Sanderson

Committee Member

Dr. Steven Browning

Committee Member

Dr. Bin Huang


Introduction: Hepatocellular carcinoma incidence and mortality rates are the rise in the United States and in Kentucky as well. According to the National Cancer Institute, there will be an estimated 40,710 new cases of liver and intrahepatic bile duct cancer and 28,920 deaths in 2017, with than 20% of 5-years survivors 1. The numbers of new cases expected by year 2030 is 37,574 2. The aim of this capstone is to assess the risk factors of late-stage diagnosis and survivability in Kentucky.

Methods: A combined dataset from the Kentucky Cancer Registry and the Behavioral Risk Factor Surveillance System was used to perform a descriptive statistics, a logistic regression and a Cox proportional-hazards regression.

Results: Of the 2,205 cases analyzed, 72.1% were males, 90.2% of white/other ethnicity, 41.1% were married and lived mostly in urban (59.5%0 and non-Appalachian region (72.1%). Their mean age at diagnosis was 64.1 years and most were diagnosed between 2005 and 2009 (81.5%) with late-stage (41.9%) and did not receive any treatment (55.3%). Our results show that black race (OR=1.5; 95% CI 1 – 2.1), gender*age interaction (male ≥ 50 years (OR=1.3; 95% CI 1.2 – 3)), uninsured status (OR=1.6; 95% CI: 1.1 – 2.5), date of diagnosis before 2000 (O%=1.8; 95%CI: 1.3 – 2.5) and residence in counties with higher levels of binge drinking proportion (OR=1.03 (1 – 1.1) increased the risk of HCC late-stage diagnosis in this Kentucky report. Appalachia residence and single status were not associated with late-stage.

HCC mean survival time in this series was 12.4 months. The mean overall survival rates for the study period were 12.9%, 24.1% and 17.2% in men, pre-and postmenopausal women, respectively. Mean specific survival rates were 34.3%, 34.5% and 37.1% in men, pre-and postmenopausal women, respectively. Early-stage at diagnosis, treatment and younger age were associated with better overall survival. Men and postmenopausal women had 40% increased risk of all-cause mortality (p=0.06). Cause-specific survival was improved by non-smoking status, recent year of diagnosis, early stage at diagnosis and treatment. Postmenopausal women had an increased risk for both all cause (OR=2.2; 95%CI: 0.9 – 5.7) and liver cancer specific mortality (OR=1.7; 95%CI: 0.4 – 3.7), compared to premenopausal women, when parity is added to the covariates.

Conclusions: HCC Late-stage diagnosis was impacted by race, age, gender, insurance status and county-level binge drinking while non-smoking status, female gender, early stage and treatment improved survival. These results highlight the need to increase healthcare access and HCC awareness in this rural state where poverty is high and education levels are lower than average to decrease the burden of HCC and improve survival.

Included in

Public Health Commons