The Impact of Race and Socioeconomic Status on Management of Potentially Resectable Pancreatic Cancer: Analysis From a Metropolitan Area in the Southeast United States

Abstract

Background

Social determinants of health are associated with differences in care and outcomes for pancreatic ductal adenocarcinoma (PDAC) patients. This study evaluates the impact of race and socioeconomic status (SES) on the presentation, management, and survival of patients with potentially resectable PDAC within a metropolitan hospital system in the Southeast United States.

Methods

A retrospective analysis of PDAC patients (2014-2020) across a multi-hospital system was performed. Associations between race as well as socioeconomic and clinicopathologic data with presentation, treatment, and survival were analyzed.

Results

Among 222 patients, 104 (46.9%) were Black and 118 (53.1%) were White. Black patients presented at a significantly younger age (61 vs 66, P = 0.007) and resided within the lowest 2 quintiles for median income (68.2% vs 42.4%, P < 0.0001). Compared with White patients, Black patients were more likely to have Medicaid/no insurance (22.1% vs 11.9%, P = 0.040). Receipt of multimodal therapy and curative intent resection was not significantly different between Black and White patients (80% vs 84.3%, P = 0.372; 46% vs 54.6%, P = 0.275), ≤50th percentile vs > 50th percentile income (79.5% vs 85.1%, P = 0.358; 47.6% vs 53.8%, P = 0.428), or Medicare/private vs Medicaid/no insurance (84.4% vs 71.4% P = 0.120; 50% vs 53.8%, P = 0.719). On survival analysis, outcomes were determined by receipt of multimodal treatment and histopathological factors but did not differ based on race or SES.

Discussion

This analysis demonstrates that patients with PDAC can receive similar treatment despite differences in race and SES. Interestingly, Black patients presented at a significantly younger age, warranting further evaluation of risk factors and tumor biology.