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

  • Pancreatic Tumors
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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.

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Acknowledgment

This research was supported by VA MERIT Review Award I01-BX003771-02 (J.S.G.).

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Authors and Affiliations

  1. Surgical Service, VA Boston Healthcare System, West Roxbury, MA, USA

    Jonathan Pastrana Del Valle MD, Edward E. Whang MD & Jason S. Gold MD

  2. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Jonathan Pastrana Del Valle MD

  3. Harvard Medical School, Boston, MA, USA

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

  4. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    George Molina MD, MPH, Mark Fairweather MD, Jiping Wang MD, PhD, Thomas E. Clancy MD, Stanley W. Ashley MD, Edward E. Whang MD & Jason S. Gold MD

  5. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Richard D. Urman MD

  6. Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Jamaica Plain, MA, USA

    Nathanael R. Fillmore PhD

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  1. Jonathan Pastrana Del Valle MD
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Del Valle, J.P., Fillmore, N.R., Molina, G. et al. Socioeconomic Disparities in Pancreas Cancer Resection and Survival in the Veterans Health Administration. Ann Surg Oncol 29, 3194–3202 (2022). https://doi.org/10.1245/s10434-021-11250-0

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