Nathanael R. Fillmore
Publications / 2022
paper
Annals of Surgical Oncology2022doi:10.1245/s10434-021-11250-0

Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration.

Valle Jonathan Pastrana Del, Nathanael R. Fillmore, George Molina, Mark Fairweather, Jiping Wang, Thomas E. Clancy, Stanley W. Ashley, Richard D. Urman, Edward E. Whang, Jason S. Gold

Summary

Patients within the Veterans Health Administration who are White, married, or retired are more likely to receive surgical resection for early-stage pancreatic cancer. These findings indicate that socioeconomic disparities in access to life-extending surgery persist even within a healthcare system designed for equal access.

Key result

Surgical resection was independently associated with White race (OR 1.35, p = 0.028), married status (OR 1.85, p = 0.001), and retirement rather than unemployment (OR 1.41, p = 0.008), while resection significantly improved median survival from 8 to 21 months (p = 0.001).

Abstract

BACKGROUND: Disparities based on socioeconomic factors such as race, ethnicity, marital status, and insurance status are associated with pancreatic cancer resection, but these disparities are usually not observed for survival after resection. It is unknown if there are disparities when patients undergo their treatment in a non-fee-for-service, equal-access healthcare system such as the Veterans Health Administration (VHA). METHODS: Patients having T1-T3 M0 pancreatic adenocarcinoma diagnosed between 2006 and 2017 were identified from the VHA Corporate Data Warehouse. Socioeconomic, demographic, and tumor variables associated with resection and survival were assessed. RESULTS: In total, 2580 patients with early-stage pancreatic cancer were identified. The resection rate was 36.5%. Surgical resection was independently associated with younger age [odds ratio (OR) 0.94, p < 0.001], White race (OR 1.35, p = 0.028), married status (OR 1.85, p = 0.001), and employment status (retired vs. unemployed, OR 1.41, p = 0.008). There were no independent associations with Hispanic ethnicity, geographic region, or Social Deprivation Index. Resection was associated with significantly improved survival (median 21 vs. 8 months, p = 0.001). Among resected patients, survival was independently associated with younger age (HR 1.019, p = 0.002), geographic region (South vs. Pacific West, HR 0.721, p = 0.005), and employment (employed vs. unemployed, HR 0.752, p = 0.029). Race, Hispanic ethnicity, marital status, and Social Deprivation Index were not independently associated with survival after resection. CONCLUSIONS: Race, marital status, and employment status are independently associated with resection of pancreatic cancer in the VHA, whereas geographic region and employment status are independently associated with survival after resection. Further studies are warranted to determine the basis for these inequities.

Key figure

Key figure from Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration.