From Street Address To Survival: Neighborhood Socioeconomic Status And Pancreatic Cancer Outcomes
*Mariam F. Eskander, *Ahmad Hamad, *Yaming Li, *Bridget Oppong, Samilia Obeng-Gyasi, *Allan Tsung
Ohio State University, Columbus, OH
OBJECTIVE(S): Neighborhood factors may influence cancer care through physical, economic, and social means. This study assesses the impact of neighborhood socioeconomic status (nSES) on diagnosis, treatment, and survival in pancreatic cancer.
METHODS: Patients diagnosed with pancreatic adenocarcinoma in 2010-2016 were identified in the Surveillance Epidemiology and End Results (SEER) database. nSES (divided into tertiles) was based on an NCI census tract-level index, a composite score that includes income, education, housing, and employment. Univariate analysis performed comparing sociodemographic and clinical variables between nSES tertiles. Multivariate models built predicting metastasis at time of diagnosis and receipt of surgery for early-stage disease and chemotherapy for metastatic disease. Overall survival (OS) compared via Kaplan-Meier and Cox proportional hazards.
RESULTS: Of 51,955 patients, 15,436 (29.7%) lived in low nSES areas, 17,509 (33.7%) in middle nSES areas, and 19,010 (36.6%) in high nSES areas. Patients with low nSES were more likely to be young (26.3% > 75 years vs. 30.8% for mid nSES and 33.2% for high nSES, p<0.001), Black (25.3% vs. 9.4% vs. 4.6%, p<0.001), Hispanic (15.1% vs.10.8% vs. 6.7%, p<0.001), single (18.1% vs. 13.5% vs. 10.5%, p<0.001), and underinsured (uninsured: 4.0% vs. 2.3% vs. 1.4%; Medicaid: 19.5% vs. 10.9% vs. 6.2%, p<0.001). On multivariate analysis, nSES was not independently associated with metastatic disease at diagnosis (low nSES OR 1.02, 95% CI 0.97-1.07; ref: high nSES). However, low nSES was associated with decreased likelihood of surgery for localized/regional disease (OR 0.76, 95% CI 0.71-0.82; ref: high nSES) and chemotherapy for metastatic disease (OR 0.65, 95% CI 0.61-0.69). nSES also predicted worse overall survival (low nSES HR 1.18, 95% CI 1.15-1.21, mid nSES 1.09, 95% CI 1.07-1.12; ref: high nSES). Kaplan-Meier curves shown in figure.
CONCLUSIONS: Patients from resource-poor neighborhoods are less likely to receive stage-appropriate therapy for pancreatic cancer and have a 18% higher risk of death. Upstream interventions are necessary to help patients who live in under-resourced areas receive necessary treatment.
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