The Impact of Residential Segregation on Pancreatic Cancer Diagnosis, Treatment, and Mortality
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ORIGINAL ARTICLE – PANCREATIC TUMORS
The Impact of Residential Segregation on Pancreatic Cancer Diagnosis, Treatment, and Mortality Barbara Aldana Blanco, MD1, Michael Poulson, MD1, Kelly M. Kenzik, MS, PhD1,2, David B. McAneny, MD1, Jennifer F. Tseng, MD, MPH1, and Teviah E. Sachs, MD, MPH1 1 2
Department of Surgery, Surgical Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
ABSTRACT Background. Disparities in pancreatic cancer outcomes between black and white patients are well documented. This study aimed to use a more novel index to examine the impact of racial segregation on the diagnosis, management, and outcomes of pancreatic cancer in black patients compared with white patients. Methods. Black and white adults with pancreatic cancer in urban counties were identified using data from the 2018 submission of the Surveillance, Epidemiology and End Results (SEER) Program and the 2010 Census. The racial index of dissimilarity (IoD), a validated proxy of racial segregation, was used to assess the evenness with which whites and blacks are distributed across census tracts in each county. Multivariate Poisson regression was performed, and stepwise models were constructed for each of the outcomes. Overall survival was studied using the Kaplan–Meier method.
To be presented in the Poster Session at the rescheduled Society of Surgical Oncology Academic Conference, Boston, MA, USA, August 17th to 18th, 2020. Barbara Aldana Blanco and Michael Poulson have contributed equally to this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09218-7) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 20 April 2020 Accepted: 14 September 2020 T. E. Sachs, MD, MPH e-mail: [email protected]
Results. The study enrolled 60,172 adults with a diagnosis of pancreatic cancer between 2005 and 2015. Overall, the black patients (13.8% of the cohort) lived in more segregated areas (IoD, 0.67 vs 0.61; p \ 0.05). They were less likely to undergo surgery for localized disease (relative risk [RR], 0.80; 95% confidence interval [CI], 0.76–0.83) and more frequently had a diagnosis of advanced-stage disease (RR, 1.09; 95% CI, 1.01–1.19) with increasing segregation. They also had shorter survival times (9.8 vs 11.4 months; p \ 0.05). Conclusions. Disparities in advanced-stage disease at diagnosis, surgery for localized disease, and overall survival are directly related to the degree of residential segregation, a proxy for structural racism. In searching for solutions to this problem, it is important to account for the historical marginalization of black Americans.
Well-established evidence shows that in the United States, black patients with pancreatic cancer have worse outcomes than whites, with shorter median survival, higher-stage disease at diagnosis, lower likelihood of oncolog
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