Census Tract–Level Persistent Poverty and Liver Cancer Survival: A Population-Based Study

BACKGROUND: Liver cancer incidence and mortality are rising in the United States, with marked racial and socioeconomic disparities. Persistent poverty, defined as communities in which ≥20% of residents have lived below the federal poverty line for ≥30 years, is an important but understudied contextual determinant of cancer survival. This study examined the association between census tract-level persistent poverty and liver cancer survival. METHODS: We analyzed 73,695 adult, population-based patients with liver cancer ages ≥20 years, diagnosed between 2006 and 2019 in the Surveillance, Epidemiology, and End Results 17 Registries. Persistent poverty status was assigned by residence at diagnosis. Cancer-specific and overall survival were estimated using Kaplan-Meier and Cox models, adjusting for demographic factors, stage at diagnosis, and initial treatment. We evaluated effect modification by age, sex, race/ethnicity, rurality, and stage at diagnosis. RESULTS: Over 168,715 person-years, 56,373 deaths occurred, of which 81% were cancer-specific. Eleven percent of patients lived in persistent poverty tracts. The median cancer-specific survival was 16 months in persistent poverty tracts versus 22 months in nonpersistent tracts (P < 0.001). In fully adjusted models, persistent poverty was associated with 9% higher cancer-specific mortality (HR = 1.09; 95% CI, 1.06-1.12) and 11% higher all-cause mortality (HR = 1.11; 95% CI, 1.09-1.14). Associations were strongest in patients