Liver Cancer Survival Linked to Disparities in Household Income

A national study in Sweden has found that individuals with low household income face a substantially higher risk of death from hepatocellular carcinoma (HCC), the most common form of primary liver cancer.

The research, carried out by scientists at the University of Gothenburg, highlights persistent disparities in diagnosis, treatment access and outcomes based on socioeconomic status. 

The research is published in The Lancet Regional Health - Europe.

Differences in diagnosis and treatment access

HCC affects around 500 to 550 people in Sweden each year, with approximately 75% of cases occurring in men. This cancer originates in the liver and is often associated with liver cirrhosis, which may develop due to chronic liver inflammation caused by alcohol misuse or a viral hepatitis infection.

In earlier work, the same research team had found that HCC incidence was around five times higher among individuals with low reported household income, compared to those with high income. The current study, which examined data from the 5,490 adults recorded in the Swedish National Liver Registry (SweLiv) between 2011 and 2021, assessed how factors such as income, education and ethnicity relate to diagnosis timing, treatment decisions and overall survival.

The socioeconomic data were retrieved from other national health registries and demographic databases. The team's results were also adjusted for factors including underlying liver disease, comorbidities and specific tumor characteristics that can affect the choice of treatment and prognosis.

The analysis found that individuals with lower income were less likely to be diagnosed at an early stage and to be offered curative treatment. Mortality among these patients was 29% higher than among those with middle or high incomes.

"The study clearly shows that socioeconomic differences are strongly linked to less favorable health outcomes at all levels of care for patients with HCC in Sweden," said lead researcher Juan Vaz, a researcher in community medicine and public health at Sahlgrenska Academy at the University of Gothenburg and a specialist physician at Halland Hospital in Halmstad. "The results underline the need for further efforts to ensure that care is truly equal and accessible to all, regardless of socioeconomic background." 

Investigating screening strategies

Given that early-stage diagnosis significantly improves the chances of receiving curative therapy, the researchers are now focused on exploring alternative, more targeted, approaches to cancer screening. 

"Targeted screening for cirrhosis of the liver in socioeconomically deprived areas can lead to early HCC diagnosis, which in turn can increase the chances of access to curative treatments, as well as all the other health benefits linked to an early cirrhosis diagnosis," said Vaz.

As a part of this effort, they are now using advanced statistical methods to identify communities and areas in Sweden where early screening for liver cirrhosis would likely have the greatest impact. Pilot studies relating to this are also being planned.

Reference: Vaz J, Hagström H, Eilard MS, Rizell M, Strömberg U. Socioeconomic inequalities in diagnostics, care and survival outcomes for hepatocellular carcinoma in Sweden: a nationwide cohort study. Lancet Reg. Health - Eur. 2025;52:101273. doi: 10.1016/j.lanepe.2025.101273

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