Impact of socioeconomic status on presentation, treatment and outcomes of patients with pancreatic cancer

Objective: To assess the impact of socioeconomic status (SES) on the patterns of care and outcomes of patients with pancreatic cancer. Materials & methods: Surveillance, Epidemiology and End Results specialized SES registry has been accessed and patients with pancreatic cancer diagnosed (2000-2015) were evaluated. The following SES variables were included: employment percentage, percent of people above the poverty line, percent of people identified as working-class, educational level, median rent, median household value and median household income. Within this SES registry, patients were classified according to their census-tract SES into three groups (where group-1 represents the lowest SES category and group-3 represents the highest SES category). Multivariable logistic regression analysis was used to assess the impact of SES on access to surgical resection and multivariable Cox regression analysis was used to assess the impact of SES on pancreatic cancer-specific survival. Kaplan-Meier survival estimates were also used to compare overall survival (OS) outcomes according to SES. Results: A total of 83,902 pancreatic cancer patients were included in the current analysis. Within multivariable logistic regression analysis among patients with a localized/regional disease, patients with lower SES were less likely to undergo surgical resection for pancreatic cancer (odds ratio: 0.719; 95% CI: 0.673-0.767; p < 0.001). Among patients with a localized/regional disease who underwent surgical resection, patients with higher SES have better OS (median OS for group-3: 20.0 vs 17.0 months for group-1; p < 0.001). Moreover, patients with lower SES have worse pancreatic cancer-specific survival compared with patients with higher SES: (hazard ratio for group-1 vs group-3: 1.212; 95% CI: 1.135-1.295; p < 0.001). Conclusion: Poor neighborhood SES is associated with more advanced disease at presentation, less probability of surgical resection and even poorer outcomes after surgical resection.