P68: The Impact of Digital Inequities on Gastrointestinal Cancer Disparities in the US

Thursday, March 23, 2023

9:31 AM – 9:36 AM

Location: SSO HUB: Rare/Metastatic Cancers Zone

Poster Presenter(s)

David J. Fei-Zhang, BA

Medical Student
Northwestern University - Feinberg School of Medicine, United States

Disclosure information not submitted.

Author(s)

David J. Fei-Zhang, BA

Medical Student
Northwestern University - Feinberg School of Medicine, United States

Disclosure information not submitted.
ZM

Zorays Moazzam, MD

Research Scholar
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, United States

Disclosure information not submitted.
EW

Erik Wu, MBioE, BS

Medical Student
Northwestern University - Feinberg School of Medicine, United States

Disclosure information not submitted.
AS

Alexander Stanisic, BS

Medical Student
Northwestern University - Feinberg School of Medicine, United States

Disclosure information not submitted.
Aslam Ejaz, MD, MPH

Assistant Professor of Surgery
The Ohio State University

Disclosure information not submitted.
Jordan M. Cloyd, MD

Assistant Professor
The Ohio State University
Columbus, OH, United States

Disclosure information not submitted.
Joal D. Beane, MD

Assistant Professor
The Ohio State University Wexner Medical Center- Division of Surgical Oncology
Columbus, Ohio, United States

Disclosure information not submitted.
Timothy M. Pawlik, MD, PhD

Chair of Surgery
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Timothy M. Pawlik, MD, PhD: No financial relationships to disclose

Introduction: In the modern era, the use of technology can substantially impact access to surgical treatment, postoperative care, and outcomes. However, the association of “digital inequities” with gastrointestinal-oncologic (GIO) outcomes remains ill-defined. We sought to develop the Digital Inequity Index (DII), a novel, self-adapted tool that quantifies access to digital resources, in order to assess its impact on GIO care and prognosis in the US.

Methods: Patients who presented with gastrointestinal malignancies between 2013-2017 were identified from the SEER database. DII was calculated based on 18 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e. electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e. education, income, disability status), ranked and then averaged into a composite score. The association between DII and surgery receipt, staging, surveillance, and survival was assessed with multiple linear and logistic regressions.

Results: Among 310,703 patients, the most common GIO primary tumor sites included colon (n=97,986, 31.5%), pancreas (n=49,796, 16.0%), liver (n=31,104, 10.0%) and esophagus (n=16,273, 5.2%). Increasing DII was associated with increased odds of presenting with late-stage disease (esophageal OR 1.02, 95%CI 1.00–1.04; hepatic OR 1.08, 95%CI 1.05–1.10; pancreatic OR 1.05, 95%CI 1.02–1.07; colon OR 1.01, 95%CI 1.00–1.02), as well as lower odds of surgical resection (esophageal OR 0.97, 95%CI 0.95–0.99; hepatic OR 0.94, 95%CI 0.93–0.96; pancreatic OR 0.96, 95%CI 0.93–0.99) (all p< 0.039). Higher DII was associated with shorter postoperative surveillance length (esophageal -8.8%; hepatic -20.4%; pancreatic -14.4%; colon -1.5%), as well as worse overall survival length (esophageal -7.6%; hepatic -14.8%; pancreatic -16.0%; colon -4.7%). Sociodemographic and infrastructure-access factors contributed equivalently to surveillance time disparities, while infrastructure-access factors had a markedly greater effect on survival disparities across GIO types.

Conclusions: Digital inequities contribute to disparities in stage at presentation, receipt of surgery, postoperative surveillance, and long-term survival among patients with GIO cancers. As technology dependence has increased, inequities in digital access should be targeted as a means of alleviating disparities in surgical oncologic care.

Learning Objectives:

Showcase the impact of modern-day digital resource inequities on gastrointestinal-oncologic care
Highlight methodologies surrounding the development of a comprehensive, self-adapted tool for comprehensively assessing digital resource measures while accounting for non-digital confounders on a national scale
Establish analyses regarding quantifiable detrimental trends derived from digital-health inequity