Skip to main content
Erschienen in:

12.04.2021 | Pancreatic Tumors

Impact of Race/Ethnicity and County-Level Vulnerability on Receipt of Surgery Among Older Medicare Beneficiaries With the Diagnosis of Early Pancreatic Cancer

verfasst von: Rosevine A. Azap, BS, Adrian Diaz, MD, MPH, J. Madison Hyer, MS, Diamantis I. Tsilimigras, MD, Rayyan S. Mirdad, MBBS, Aslam Ejaz, MD, Timothy M. Pawlik, MD, MPH, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Patients can experience barriers and disparities to access high-quality cancer care. This study sought to characterize receipt of surgery and chemotherapy among Medicare beneficiaries with a diagnosis of early-stage pancreatic adenocarcinoma cancer (PDAC) relative to race/ethnicity and social vulnerability.

Methods

The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify patients with a diagnosis of early-stage (stage 1 or 2) PDAC between 2004 and 2016. Data were merged with the CDC’s Social Vulnerability Index (SVI) at the beneficiary’s county of residence. Multivariable, mixed-effects logistic regression was used to assess the association of SVI with resection.

Results

Among 15,931 older Medicare beneficiaries with early-stage PDAC (median age, 77 years; interquartile range [IQR], 71–82 years), the majority was White (n = 12,737, 80.0 %), whereas a smaller subset was Black or Latino (n = 3194, 20.0 %) A minority of patients was more likely to live in highly vulnerable communities (low SVI: white [90.5 %] vs minority [9.5 %] vs high SVI: white [71.9 %] vs minority [28.1 %]; p < 0.001). Use of resection for early-stage PDAC was lowest among the patients who resided in high-SVI areas (low [38.0 %] vs average [34.3 %] vs high [31.9 %]; p < 0.001). The minority patients were less likely to undergo resection than the White patients (no resection: white [64.1 %] vs minority [70.7 %]; p < 0.001). The median SVI was higher among the patients who underwent resection (57.6; IQR, 36.0–81.0) than among those who did not (60.4; IQR, 41.9–84.3), and increased SVI resulted in a decline in the likelihood of resection (SVI trend: OR, 0.98; 95 % confidence interval [CI], 0.97–1.00), especially among the minority patients. Minority patients from high-SVI counties had markedly lower odds of preoperative chemotherapy than minority patients from a low-SVI neighborhood (OR, 0.62; 95 % CI, 0.52–0.73).

Conclusions

Older Medicare beneficiaries with early-stage PDAC residing in counties with higher social vulnerability had lower odds of undergoing pancreatic resection, which was more pronounced among minority versus older White Medicare beneficiaries.
Literatur
1.
Zurück zum Zitat Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19:1154–9.CrossRef Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19:1154–9.CrossRef
2.
Zurück zum Zitat Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.PubMedPubMedCentral Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.PubMedPubMedCentral
3.
Zurück zum Zitat Wallen J, Waitzkin H, Stoeckle J. Physician stereotypes about female health and illness: a study of patient’s sex and the informative process during medical interviews. Women Health. 1979;4:135–46.CrossRef Wallen J, Waitzkin H, Stoeckle J. Physician stereotypes about female health and illness: a study of patient’s sex and the informative process during medical interviews. Women Health. 1979;4:135–46.CrossRef
4.
Zurück zum Zitat Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff Millwood. 2002;21:60–76.CrossRef Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff Millwood. 2002;21:60–76.CrossRef
6.
Zurück zum Zitat Buchmueller TC, Levinson ZM, Levy HG, et al. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106:1416–21.CrossRef Buchmueller TC, Levinson ZM, Levy HG, et al. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106:1416–21.CrossRef
8.
Zurück zum Zitat Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health. 2010;100(Suppl 1):S186–96.CrossRef Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health. 2010;100(Suppl 1):S186–96.CrossRef
10.
Zurück zum Zitat Frist WH. Overcoming disparities in U.S. health care. Health Aff Millwood. 2005;24:445–51. Frist WH. Overcoming disparities in U.S. health care. Health Aff Millwood. 2005;24:445–51.
11.
Zurück zum Zitat Shavers VL. Racial and ethnic disparities in the receipt of cancer treatment. CancerSpectrum Knowl Environ. 2002;94:334–57. Shavers VL. Racial and ethnic disparities in the receipt of cancer treatment. CancerSpectrum Knowl Environ. 2002;94:334–57.
12.
Zurück zum Zitat Basu A, Ghosh D, Mandal B, et al. Barriers and explanatory mechanisms in diagnostic delay in four cancers: a health-care disparity? South Asian J Cancer. 2019;8:221–5.CrossRef Basu A, Ghosh D, Mandal B, et al. Barriers and explanatory mechanisms in diagnostic delay in four cancers: a health-care disparity? South Asian J Cancer. 2019;8:221–5.CrossRef
13.
Zurück zum Zitat Gamboa AC, Rupji M, Switchenko JM, et al. Optimal timing and treatment strategy for pancreatic cancer. J Surg Oncol. 2020;122:457–68.CrossRef Gamboa AC, Rupji M, Switchenko JM, et al. Optimal timing and treatment strategy for pancreatic cancer. J Surg Oncol. 2020;122:457–68.CrossRef
14.
Zurück zum Zitat Vick AD, Hery DN, Markowiak SF, et al. Closing the disparity in pancreatic cancer outcomes: a closer look at nonmodifiable factors and their potential use in treatment. Pancreas. 2019;48:242–9.CrossRef Vick AD, Hery DN, Markowiak SF, et al. Closing the disparity in pancreatic cancer outcomes: a closer look at nonmodifiable factors and their potential use in treatment. Pancreas. 2019;48:242–9.CrossRef
15.
Zurück zum Zitat Gold JS. Linking disparities to outcomes in pancreatic cancer: inching toward answers. JAMA Surg. 2020;155:e195082.CrossRef Gold JS. Linking disparities to outcomes in pancreatic cancer: inching toward answers. JAMA Surg. 2020;155:e195082.CrossRef
17.
Zurück zum Zitat Tavakkoli A, Singal AG, Waljee AK, et al. Racial disparities and trends in pancreatic cancer incidence and mortality in the United States. Clin Gastroenterol Hepatol. 2020;18(171–178):e10. Tavakkoli A, Singal AG, Waljee AK, et al. Racial disparities and trends in pancreatic cancer incidence and mortality in the United States. Clin Gastroenterol Hepatol. 2020;18(171–178):e10.
18.
Zurück zum Zitat Heller DR, Nicolson NG, Ahuja N, et al. Association of treatment inequity and ancestry with pancreatic ductal adenocarcinoma survival. JAMA Surg. 2020;155:e195047.CrossRef Heller DR, Nicolson NG, Ahuja N, et al. Association of treatment inequity and ancestry with pancreatic ductal adenocarcinoma survival. JAMA Surg. 2020;155:e195047.CrossRef
19.
Zurück zum Zitat Noel M, Fiscella K. Disparities in pancreatic cancer treatment and outcomes. Health Equity. 2019;3:532–40.CrossRef Noel M, Fiscella K. Disparities in pancreatic cancer treatment and outcomes. Health Equity. 2019;3:532–40.CrossRef
20.
Zurück zum Zitat Khawja SN, Mohammed S, Silberfein EJ, et al. Pancreatic cancer disparities in African Americans. Pancreas. 2015;44:522–7.CrossRef Khawja SN, Mohammed S, Silberfein EJ, et al. Pancreatic cancer disparities in African Americans. Pancreas. 2015;44:522–7.CrossRef
21.
Zurück zum Zitat Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7:525–35.CrossRef Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7:525–35.CrossRef
23.
Zurück zum Zitat Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th-edition AJCC pancreatic cancer staging system. Cancer. 2007;110:738–44.CrossRef Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th-edition AJCC pancreatic cancer staging system. Cancer. 2007;110:738–44.CrossRef
25.
Zurück zum Zitat Quan H, Li B, Couris CM, et al. Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82.CrossRef Quan H, Li B, Couris CM, et al. Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82.CrossRef
31.
Zurück zum Zitat Xu L, Kim Y, Spolverato G, et al. Racial disparities in treatment and survival of patients with hepatocellular carcinoma in the United States. Hepatobiliary Surg Nutr. 2016;5:43–52.CrossRef Xu L, Kim Y, Spolverato G, et al. Racial disparities in treatment and survival of patients with hepatocellular carcinoma in the United States. Hepatobiliary Surg Nutr. 2016;5:43–52.CrossRef
32.
Zurück zum Zitat Nathan H, Frederick W, Choti MA, et al. Racial disparity in surgical mortality after major hepatectomy. J Am Coll Surg. 2008;207:312–9.CrossRef Nathan H, Frederick W, Choti MA, et al. Racial disparity in surgical mortality after major hepatectomy. J Am Coll Surg. 2008;207:312–9.CrossRef
33.
Zurück zum Zitat Khubchandani JA, Shen C, Ayturk D, et al. Disparities in access to emergency general surgery care in the United States. Surgery. 2018;163:243–50.CrossRef Khubchandani JA, Shen C, Ayturk D, et al. Disparities in access to emergency general surgery care in the United States. Surgery. 2018;163:243–50.CrossRef
35.
Zurück zum Zitat Chen JT, Rehkopf DH, Waterman PD, et al. Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999–2001. J Urban Health Bull N Y Acad Med. 2006;83:1063–84.CrossRef Chen JT, Rehkopf DH, Waterman PD, et al. Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999–2001. J Urban Health Bull N Y Acad Med. 2006;83:1063–84.CrossRef
38.
Zurück zum Zitat Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80–94. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80–94.
39.
Zurück zum Zitat Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol. 2015;41:311–30.CrossRef Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol. 2015;41:311–30.CrossRef
40.
Zurück zum Zitat Lucyk K, McLaren L. Taking stock of the social determinants of health: a scoping review. Plos One. 2017;12:e0177306.CrossRef Lucyk K, McLaren L. Taking stock of the social determinants of health: a scoping review. Plos One. 2017;12:e0177306.CrossRef
41.
Zurück zum Zitat Taylor LA, Tan AX, Coyle CE, et al. Leveraging the social determinants of health: what Works? Plos One. 2016;11:e0160217.CrossRef Taylor LA, Tan AX, Coyle CE, et al. Leveraging the social determinants of health: what Works? Plos One. 2016;11:e0160217.CrossRef
Metadaten
Titel
Impact of Race/Ethnicity and County-Level Vulnerability on Receipt of Surgery Among Older Medicare Beneficiaries With the Diagnosis of Early Pancreatic Cancer
verfasst von
Rosevine A. Azap, BS
Adrian Diaz, MD, MPH
J. Madison Hyer, MS
Diamantis I. Tsilimigras, MD
Rayyan S. Mirdad, MBBS
Aslam Ejaz, MD
Timothy M. Pawlik, MD, MPH, PhD
Publikationsdatum
12.04.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-09911-1

Neu im Fachgebiet Chirurgie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Appendizitis und Darminfarkt durch Blinddarm-Lipom

Eigentlich sind Lipome recht harmlos. Im Zäkum können sie jedoch erhebliche Komplikationen mit Darminfarkt und Appendizitis verursachen.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

MedTalk Leitlinie KOMPAKT: S3-Leitline zu peripheren Nervenverletzungen

  • Webinar | 10.02.2025 | 13:00

Über den Weg zur finalen Fassung der S3-Leitlinie "Versorgung peripherer Nervenverletzungen" sprechen Prof. Dr. Leila Harhaus-Wähner und Ressortleiter Dr. Gunter Freese im WebTalk Leitlinie KOMPAKT, einer neuen Webcast-Serie von SpringerMedizin passend zu Ihrem Fachmagazin Orthopädie und Unfallchirurgie Mitteilungen und Nachrichten. In dem kurzen Video geht es darum, was sich im Vergleich zur vorigen Fassung der Leitlinie geändert hat, welche Aspekte für die tägliche Praxis besonders wichtig sind und was jeder gemäß Leitlinie nun anders oder besser machen sollte.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.