Quyen D Chu1, Mei-Chin Hsieh2, John F Gibbs3, Xiao-Cheng Wu2. 1. Departments of Surgery, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana, USA. 2. Louisiana Tumor Registry & Epidemiology and School of Public Health at LSU Health Sciences-New Orleans, New Orleans, Louisiana, USA. 3. Hackensack Meridian School of Medicine, Nutley, NJ, USA.
Abstract
BACKGROUND: The impact of rurality on outcome for patients who had resected pancreatic ductal adenocarcinoma (PDAC) is unclear. We hypothesize that poor outcomes for rural patients are associated with adverse social determinants of health (SDoH). The objective of this study is to assess the difference in overall survival (OS) of PDAC patients between rural, urban, and contributing factors. METHODS: A cohort of 25,536 patients diagnosed with stage I-III pancreatic adenocarcinoma from 2003 to 2011 and underwent resection were evaluated from the National Cancer Database. Socioeconomic/demographic, clinicopathological, and treatment variables were compared between rural and urban residences. The 5-year OS was calculated using the Kaplan-Meier method. The Cox regression model was used to assess factors associated with OS. P value <0.05 was considered significant. RESULTS: In univariate analysis, the rural residence was a predictor of poor OS. The 5-year OS for rural (N=4,389) and urban (N=21,147) was 18.8% (95% CI: 17.4-20.2%) and 22.3% (95% CI: 21.6-22.9%; P<0.0001), respectively. The risk of all causes of death was 10.3% higher (P<0.0001) in rural than urban patients. In multivariable analysis, rurality was not an independent predictor of OS (P=0.407). Independent predictors of worse OS included adverse social determinants of health associated with the rural population and these included a low income (P<0.0001), low education level (P<0.01), low insurance status (P<0.01), and treatment at a low-volume facility (P<0.0001). CONCLUSIONS: Rural/urban outcome disparities for resected stage I-III pancreatic cancer outcome can be explained by adverse social determinants of health associated with rural population. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
BACKGROUND: The impact of rurality on outcome for patients who had resected pancreatic ductal adenocarcinoma (PDAC) is unclear. We hypothesize that poor outcomes for rural patients are associated with adverse social determinants of health (SDoH). The objective of this study is to assess the difference in overall survival (OS) of PDAC patients between rural, urban, and contributing factors. METHODS: A cohort of 25,536 patients diagnosed with stage I-III pancreatic adenocarcinoma from 2003 to 2011 and underwent resection were evaluated from the National Cancer Database. Socioeconomic/demographic, clinicopathological, and treatment variables were compared between rural and urban residences. The 5-year OS was calculated using the Kaplan-Meier method. The Cox regression model was used to assess factors associated with OS. P value <0.05 was considered significant. RESULTS: In univariate analysis, the rural residence was a predictor of poor OS. The 5-year OS for rural (N=4,389) and urban (N=21,147) was 18.8% (95% CI: 17.4-20.2%) and 22.3% (95% CI: 21.6-22.9%; P<0.0001), respectively. The risk of all causes of death was 10.3% higher (P<0.0001) in rural than urban patients. In multivariable analysis, rurality was not an independent predictor of OS (P=0.407). Independent predictors of worse OS included adverse social determinants of health associated with the rural population and these included a low income (P<0.0001), low education level (P<0.01), low insurance status (P<0.01), and treatment at a low-volume facility (P<0.0001). CONCLUSIONS: Rural/urban outcome disparities for resected stage I-III pancreatic cancer outcome can be explained by adverse social determinants of health associated with rural population. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
Authors: Lola Rahib; Benjamin D Smith; Rhonda Aizenberg; Allison B Rosenzweig; Julie M Fleshman; Lynn M Matrisian Journal: Cancer Res Date: 2014-06-01 Impact factor: 12.701
Authors: Waddah B Al-Refaie; Binyam Muluneh; Wei Zhong; Helen M Parsons; Todd M Tuttle; Selwyn M Vickers; Elizabeth B Habermann Journal: J Am Coll Surg Date: 2011-11-23 Impact factor: 6.113
Authors: Melissa M Murphy; Jessica P Simons; Joshua S Hill; Theodore P McDade; Sing Chau Ng; Giles F Whalen; Shimul A Shah; Lynn H Harrison; Jennifer F Tseng Journal: Cancer Date: 2009-09-01 Impact factor: 6.860
Authors: Kassandra I Alcaraz; Tracy L Wiedt; Elvan C Daniels; K Robin Yabroff; Carmen E Guerra; Richard C Wender Journal: CA Cancer J Clin Date: 2019-10-29 Impact factor: 508.702
Authors: Robert W Eppsteiner; Nicholas G Csikesz; James T McPhee; Jennifer F Tseng; Shimul A Shah Journal: Ann Surg Date: 2009-04 Impact factor: 12.969
Authors: Lisa Scarton; Saunjoo Yoon; Sungho Oh; Edward Agyare; Jose Trevino; Bo Han; Eunsook Lee; Veronica Wendy Setiawan; Jennifer B Permuth; Thomas D Schmittgen; Folakemi G Odedina; Diana J Wilkie Journal: Cancers (Basel) Date: 2018-07-18 Impact factor: 6.639
Authors: Mia Shepherdson; Shalem Leemaqz; Gurmeet Singh; Courtney Ryder; Shahid Ullah; Karla Canuto; Joanne P Young; Timothy J Price; Ross A McKinnon; Stephen J Pandol; Claire T Roberts; Savio George Barreto Journal: Cancers (Basel) Date: 2022-06-10 Impact factor: 6.575