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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgments

Adrian Diaz receives funding from the University of Michigan Institute for Healthcare Policy and Innovation Clinician Scholars Program and received salary support from the Veterans Affairs Office of Academic Affiliations during this study. The remaining authors have no conflicts of interest. The views expressed in this article are not necessarily represent those of the United States Government or the Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA

    Rosevine A. Azap BS, Adrian Diaz MD, MPH, J. Madison Hyer MS, Diamantis I. Tsilimigras MD, Aslam Ejaz MD & Timothy M. Pawlik MD, MPH, PhD

  2. National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Adrian Diaz MD, MPH

  3. Royal College of Surgeons, Dublin, Ireland

    Rayyan S. Mirdad MBBS

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  1. Rosevine A. Azap BS
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Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Azap, R.A., Diaz, A., Hyer, J.M. et al. Impact of Race/Ethnicity and County-Level Vulnerability on Receipt of Surgery Among Older Medicare Beneficiaries With the Diagnosis of Early Pancreatic Cancer. Ann Surg Oncol 28, 6309–6316 (2021). https://doi.org/10.1245/s10434-021-09911-1

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