open access publication

Article, 2024

Inequities in primary liver cancer in Europe: The state of play

Journal of Hepatology, ISSN 1600-0641, 0168-8278, Volume 80, 4, Pages 645-660, 10.1016/j.jhep.2023.12.031

Contributors

Kondili, Loreta Anesti 0000-0003-2656-224X [1] Lazarus, Jeffrey Victor 0000-0001-9618-2299 [2] [3] [4] Jepsen, Peter 0000-0002-6641-1430 [5] Murray, Frank [6] Schattenberg, Jörn Markus 0000-0002-4224-4703 [7] Korenjak, Marko 0000-0003-4024-677X [8] Craxì, Lucia 0000-0002-3997-1504 [9] Buti, María Asunción 0000-0002-0732-3078 (Corresponding author) [10] [11]

Affiliations

  1. [1] Istituto Superiore di Sanità
    2. [NORA names: Italy; Europe, EU; OECD];
  2. [2] City University of New York
    3. [NORA names: United States; America, North; OECD];
  3. [3] Hospital Clínic de Barcelona
    4. [NORA names: Spain; Europe, EU; OECD];
  4. [4] University of Barcelona
    5. [NORA names: Spain; Europe, EU; OECD];
  5. [5] Aarhus University Hospital
    6. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];

Abstract

Given the increasing burden of liver cancer in Europe, it is crucial to investigate how social determinants of health (SDoH) affect liver cancer risk factors and access to care in order to improve health outcomes equitably. This paper summarises the available evidence on the differential distribution of liver cancer risk factors, incidence, and health outcomes in the European Economic Area and the United Kingdom from an SDoH perspective. Vulnerable and marginalised populations have low socio-economic and educational levels and are the most affected by liver cancer risk factors. Reasons for this include varied access to hepatitis B virus vaccination and limited access to viral hepatitis B and C screening, harm reduction, and treatment. Additionally, alcohol-related liver disease remains highly prevalent among individuals with low education, insecure employment, economic instability, migrants, and deprived populations. Moreover, significant variation exists across Europe in the proportion of adults with steatotic liver disease, overweight/obesity, and diabetes, based on geographical area, gender, socio-economic and educational background, and density of ultra-processed food outlets. Inequities in cirrhosis mortality rates have been reported, with the highest death rates among individuals living in socio-economically disadvantaged areas and those with lower educational levels. Furthermore, insufficient healthcare access for key populations with primary liver cancer is influenced by complex healthcare systems, stigmatisation, discrimination, low education, language barriers, and fear of disclosure. These challenges contribute to inequities in liver cancer care pathways. Future studies are needed to explore the different SDoH-interlinked effects on liver cancer incidence and outcomes in European countries. The ultimate goal is to develop evidence-based multilevel public health interventions that reduce the SDoH impact in precipitating and perpetuating the disproportionate burden of liver cancer in specific populations.

Keywords

B virus vaccine, Economic Area, Europe, European, European Economic Area, European countries, Kingdom, SDoH, United Kingdom, access, adults, alcohol-related liver disease, area, background, barriers, burden of liver cancer, cancer, cancer care pathway, cancer incidence, cancer risk factors, care pathways, cirrhosis, cirrhosis mortality rates, complex healthcare system, countries, death rate, density, deprived populations, determinants of health, diabetes, differential distribution, disadvantaged areas, disclosure, discrimination, disease, disproportionate burden, economic instability, education, education level, educational background, effect, employment, evidence, factors, fear, fear of disclosure, food outlets, gender, geographical areas, goal, harm, harm reduction, health, health interventions, health outcomes, healthcare access, healthcare system, hepatitis, hepatitis B, hepatitis B virus vaccine, highest death rate, impact, improve health outcomes, incidence, increasing burden, individuals, inequality, insecure employment, instability, insufficient healthcare access, intervention, language, language barriers, levels, liver, liver cancer, liver cancer incidence, liver cancer risk factors, liver disease, low educational level, low socio-economic, lower education, marginalised populations, migrants, mortality rate, outcomes, outlet, overweight/obesity, pathway, perspective, population, precipitation, primary liver cancer, proportion, proportion of adults, public health interventions, rate, reasons, reduction, risk factors, screening, significant variation, social determinants, social determinants of health, socio-economic, socio-economically disadvantaged areas, state, steatotic liver disease, stigmatisation, study, system, treatment, units, vaccine, variation, viral hepatitis B

Funders

  • Government of Catalonia

Data Provider: Digital Science

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