98: Disparities in Receipt of Complex GI Cancer Surgery at a Small Geographic Scale

Friday, March 24, 2023

11:11 AM – 11:21 AM

Location: Ballroom A

Abstract Presenter(s)

Richard S. Hoehn, MD

Assistant Professor of Surgery
University Hospitals, Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

WD

Weichuan Dong, Ph. D.

Research Associate
Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

Disclosure(s): No financial relationships to disclose

Author(s)

MK

Matthew Kucmanic, PhD

Research Associate
University of Iowa, United States

Disclosure information not submitted.
JW

Jordan Winter, MD

Professor of Surgery
University Hospitals, United States

Disclosure information not submitted.
PP

Peter Pronovost, MD PhD

Chief Quality & Clinical Transformation Officer
University Hospitals, United States

Disclosure information not submitted.
JR

Johnie Rose, MD PhD

Assistant Professor
Dept of Population and Quantitative Health Sciences, United States

Disclosure information not submitted.
UK

Uriel Kim, n/a

Student
CWRU School of Medicine, United States

Disclosure information not submitted.
SK

Siran Koroukian, PhD

Professor
Dept of Population and Quantitative Health Sciences, United States

Disclosure information not submitted.

Disclosure(s):

Richard S. Hoehn, MD: No financial relationships to disclose

Weichuan Dong, Ph. D.: No financial relationships to disclose

Introduction: Disparities in the receipt of surgery for complex gastrointestinal (GI) cancers exist due to non-medical patient factors. However, these inequities are poorly understood at the neighborhood level, which limits our ability to intervene.

Methods: Using Ohio Department of Health data, we identified patients with non-metastatic esophageal, gastric, pancreatic, hepatic, and biliary cancers from 2009-2018. To balance the need for fine geographic scale with patient privacy concerns, we combined census tracts into the smallest geographic areas that included a minimum number of cases (n=11) using the Max-p-regions method and called these areas “MaxTracts”. Age-adjusted surgery rates were calculated, and hot spot analysis identified clusters of high and low surgery rates. CDC and US Census data were used to compare neighborhood characteristics between the high- and low-surgery clusters.

Results: 33,091 patients were diagnosed with non-metastatic complex GI cancers. Among 1,006 MaxTracts in the state of Ohio, rates of surgery ranged from 20.7% to 92.3% (median: 48.8, IQR: 42.4-56.3). Low-surgery clusters were mostly in urban cores and the Appalachian region, whereas high-surgery clusters were mostly in the suburbs (Figure 1). However, there was a non-uniform distribution of clusters across major cities and the urban and rural regions. There were statistically significant differences in neighborhood characteristics between groups, with low-surgery clusters having fewer married households (40% vs 50%) and higher rates of poverty (23% vs 12%), tobacco use (25% vs 19%), and obesity (39% vs 35%; all p< 0.01).

Conclusions: Dramatic neighborhood-level inequities exist for receipt of complex GI cancer surgery. Common social determinants of health only partially explain these findings, and qualitative studies are needed to better understand the causes. These methods will guide the development of disparities-focused interventions.

Learning Objectives:

understand inequities in receipt of complex GI cancer surgery
discuss neighborhood-level variation in the receipt of complex GI cancer surgery
describe potential applications of these novel methods