80: Disparities in Socioeconomic Mediation of Racial Segregation in Hepatopancreaticobiliary Cancer

Friday, March 24, 2023

3:10 PM – 3:22 PM

Location: Veterans Memorial Auditorium

Author(s)

Muhammad Musaab Munir, MBBS

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

Disclosure(s): No financial relationships to disclose
SW

Selamawit Woldesenbet, MSc, PhD

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

Disclosure information not submitted.
Yutaka Endo, MD, PhD

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

Disclosure(s): No financial relationships to disclose
HA

Henrique Araujo Lima, MD

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

Disclosure information not submitted.
LA

Lovette Azap, n/a

Medical Student
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 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.
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.
Alex C. Kim, MD, PhD

Assistant Professor of Surgery
The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute
Columbus, Ohio, United States

Disclosure information not submitted.
Aslam Ejaz, MD, MPH

Assistant Professor of Surgery
The Ohio State University

Disclosure information not submitted.

Author(s)

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

Abstract Presenter(s)

Muhammad Musaab Munir, MBBS

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

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Muhammad Musaab Munir, MBBS: No financial relationships to disclose

Yutaka Endo, MD, PhD: No financial relationships to disclose

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

Introduction: Structural racism within the U.S. healthcare system continues to contribute to disparities in access to surgical care and outcomes. In turn, although the Index of Dissimilarity (IoD) has traditionally been employed to study racial segregation in labor markets and housing, its impact on hepatopancreaticobiliary (HPB) oncologic outcomes remains unexplored. We sought to examine the impact of IoD on the diagnosis, treatment and outcomes of HPB cancer, as well as the mediating socioeconomic factors that contribute to racial segregation.

Methods: Patients who belonged to Black and White racial groups and presented with HPB cancer between 2005-2015 were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The racial IoD was derived from the 2010 U.S. Census and used as a validated measure of segregation. The primary outcomes of interest were early stage at diagnosis, surgery for localized disease and overall mortality. Principal Component Analysis was used to determine the socioeconomic mediators of racial segregation, while Generalized Structural Equation Modelling was utilized to quantify their mediating effect.

Results: Among 39,063 patients enrolled in the study, 86.4% (n=33,749) were White and 13.6% (n=5,314) were Black. Black patients were more likely to reside in segregated areas as compared with White patients (median IoD, 0.62 vs 0.52; p< 0.05). Notably, Black patients in highly segregated areas were less likely to present with early-stage disease (relative risk (RR) 0.89, 95% CI 0.82-0.95; p< 0.05) and to receive surgery for localized disease (RR 0.81, 95% CI 0.70-0.91; p< 0.05). Moreover, compared with White patients living in low segregation, Black patients in highly segregated areas had a 12% increase in mortality hazards (HR 1.12, 95% CI 1.06-1.17; p< 0.05). When considering the socioeconomic mediators of these associations, poverty, education, living in crowded conditions and insurance status contributed to 15% of the total effect on early stage, while average income, house price and income mobility contributed to 17% of the total effect on surgical resection. Notably, average income, house price and income mobility also accounted for 59% of the total effect of racial segregation on 5-year survival.

Conclusions: Racial segregation and its underlying socioeconomic factors have a marked impact on disparities in access to surgical care and outcomes. Local and federal policies targeted at addressing these factors are critically needed to foster the growth of an equitable healthcare system.

Learning Objectives:

Assess the impact of racial segregation on the diagnosis, treatment and outcomes of hepatopancreaticobiliary cancer.
Identify the socioeconomic factors that are responsible for mediating the effect of racial segregation.
Determine the mediating effect of socioeconomic factors on hepatopancreaticobiliary cancer diagnosis, treatment and outcomes.