Team Science and Disparities in Surgical Oncologic Care
Gilbert Z. Murimwa, MD
Surgical Resident
UT Southwestern
Dallas, Texas, United States
Disclosure: Disclosure information not submitted.
For patients with pancreatic adenocarcinoma (PC), home address and other social determinants of health may predict prognosis and outcomes. The area deprivation index (ADI) is a validated measure that quantifies socioeconomic disadvantage based on income, education, employment, and housing quality. It has been suggested that ADI may be a better surrogate for populations at risk than zip code-based models. In this study, we aim to determine the association between ADI and patient access to specialized oncologic care and overall survival (OS).
Methods:
The Texas Cancer Registry was queried to identify patients diagnosed with PC from 2004-2015. ADI was calculated based on patients’ census block groupings. Specialized oncologic care was defined as treatment at an ACS-accredited, NIH-designated, or high-volume facility ( >20 resections/year). A multivariate regression model (MVA) was used to associate ADI with specialized care and OS. OS was estimated using the Kaplan-Meier method and compared using log-rank tests.
Results:
For 10862 patients, 2 year survival rate was greater in the lowest ADI decile compared to the highest decile (14.9%, 9% respectively, p < 0.001) and on MVA, residence in the two highest ADI deciles was associated with increased risk of mortality compared to the lowest decile (HR 1.15,1.24; 95% CI 1.04 – 1.27, 1.13-1.35; p = 0.005, p< 0.001 respectively). Additional covariates associated with worse OS included Black race, Medicare insurance, advanced SEER stage, failure to operate, failure to receive chemotherapy, and area deprivation (All p < 0.05). ADI in the 4thdecile and higher was consistently associated with decreased access to specialized oncologic care with a 53% reduction in access for patients in the 10th decile (OR 0.47, 95% CI 0.37–0.60, p< 0.001). Rural patients suffered a similar disparity (OR 0.52, 95% CI 0.46–0.58, p< 0.001).
Conclusions:
Higher ADI is associated with decreased OS and access to specialized cancer centers for PC patients. ADI independently predicts risk of death and is an important tool for identifying disparities in access and OS which can inform tailored interventions for communities at risk.