{
  "abstract": "Introduction Socioeconomic deprivation has been linked to adverse hepatocellular carcinoma (HCC) outcomes, but its influence on patient adherence to HCC surveillance remains unclear, particularly in the UK.Methods We conducted a retrospective cohort analysis of individuals enrolled in primary HCC surveillance across two hospitals in Greater Manchester between 2016–2019. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD), dichotomised into high (IMD 1–5) and low (IMD 6–10) deprivation groups. Surveillance adherence was quantified as the proportion of time covered (PTC) by surveillance imaging, with each surveillance scan providing six months’ ‘coverage’ in accordance with UK guideline recommendations. A zero–one-inflated beta regression model was used to evaluate both partial (PTC strictly between 0% and 100%) and perfect adherence (PTC = 100%) to surveillance, adjusting for age, sex, ethnicity, liver disease aetiology, presence of ascites, hepatic encephalopathy, and duration of follow-up. Multivariable logistic regression was employed to assess the secondary outcome: the association between socioeconomic deprivation and treatment intent (curative vs. palliative) among patients with incident HCC.Results A total of 1,477 patients were followed for a median of 24.2 months (IQR: 12.1–38.4), during which time 3,350 surveillance scans were performed. The median PTC by surveillance imaging was 55.5% (IQR: 32.9%–86.0%). Of these, 1,411 patients with complete IMD data were included in zero–one-inflated beta regression analysis. Among individuals achieving partial surveillance (n = 1,201), lower deprivation (IMD 6–10) was independently associated with higher surveillance coverage (adjusted OR = 1.15, 95% CI: 1.03–1.29, p = 0.017). Older age and duration of follow up were significant covariates. Perfect surveillance adherence (PTC = 100%) was observed in 208 patients; in this group, no significant association was found between deprivation and surveillance coverage (adjusted OR 1.04, 95% CI 0.50–2.13; p = 0.921). Of 97 patients diagnosed with HCC during follow-up, socioeconomic deprivation was not associated with curative (vs palliative) treatment intent (adjusted OR = 0.67, 95% CI 0.19-2.29, p = 0.518).Conclusions We set out to better understand the impact of socioeconomic deprivation on how patients adhere to HCC surveillance protocols. In this study, socioeconomic deprivation was inversely associated with partial surveillance coverage. However, deprivation was not associated with perfect (100% PTC) HCC surveillance or treatment intent among patients with incident HCC. These findings provide novel UK-specific evidence that deprivation influences engagement with long-term surveillance, highlighting the need for targeted interventions to mitigate the cumulative impact of deprivation on long-term surveillance.",
  "authors": [
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Kevin Kuriakose"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Christopher Mysko"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom",
        "Manchester Academic Health Science Centre, Manchester, United Kingdom"
      ],
      "name": "Azita Rajai"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Darren Griffiths"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Stephanie Landi"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Huw Purssell"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Oliver Street"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Deepankar Gahloth"
    },
    {
      "affiliations": [
        "Roche Diagnostics Limited, Burgess Hill, United Kingdom"
      ],
      "name": "A Joy Allen"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Karen Piper Hanley"
    },
    {
      "affiliations": [
        "University of Birmingham, Birmingham, United Kingdom",
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Neil Hanley"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Tracey Farragher"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Varinder Singh Athwal"
    }
  ],
  "title": "P73 Socioeconomic deprivation influences adherence to hepatocellular carcinoma surveillance: a UK cohort study",
  "uid": "1c6d75a3-1481-543c-9c55-09f0730604c9"
}