Abstract 3946: Weaving equity into the fabric of health: A deep dive into race, social determinants of health and facility type in pancreatic adenocarcinoma care
Authors: Wu Christopher , Song Zhixing , Akhund Ramsha , McLeod Chandler , Wood Lauren , Chen Herbert , Rose J. Bart , Bhatia Smita , Gillis Andrea 
Published: March 2024

Introduction: Pancreatic adenocarcinoma (PDAC) remains one of the deadliest malignancies, with significant differences in survival rates observed among various racial and ethnic groups. Despite advancements in care, ongoing racial disparities stress the need to uncover underlying causes. This study seeks to evaluate the interplay of race, social determinants of health, and treatment facility on overall survival (OS) of PDAC patients.

Methods: In this retrospective cohort study, we identified PDAC patients from January 1, 2004, to December 31, 2019, using National Cancer Database (NCDB) data. Patients not receiving treatment (surgery, chemotherapy, or radiation) or who were missing race were excluded. We performed a multivariable cox proportional hazards regression to explore the race and all-cause mortality relationship, stratified by facility type and income status. Patients were divided into income quartiles (SES) with the lowest SES represented by median zip code level income ≤$40,227, while highest SES indicated income levels ≥$63,333. Treating facility type included community or academic hospital. A two-sided P-value &lt;0.05 was considered significant.

Results: The total cohort included 210,520 patients. The average age of the cohort was 66.4 (SD:10.7) years and most patients were white (80%, N=168,467), male (52.2%, N=109,844), treated at academic facility type (65.5%, N=136,623), and the highest SES was the largest (38.4%, N=71,205). In unadjusted analysis, Black patients had lower OS than Whites (HR: 1.05 (95% CI: 1.04-1.07, p&lt;0.001)). As SES increases there was a corresponding decrease in hazards (p&lt;0.001). In the multivariable subgroup analysis, survival were not significant for Black and White patients in highest SES at academic facilities (p=0.8). Of note, highest SES Black patients in community hospitals had worse survival than highest SES White patients (HR: 1.08 (95% CI:1.01-1.16, p=0.03)). However, lowest SES Blacks treated at academic facilities had superior survival compared to lowest SES Whites (HR: 0.93 (95% CI: 0.89-0.96, p&lt;0.001)).

Conclusion: Survival differences among Black individuals were linked to SES and facility type. Highest SES was not protective for Black patients treated at community hospitals compared to their White counterparts, indicating additional factors driving outcomes. These findings highlight the intricate influence of race, SES, and perhaps biology on survival outcomes. Addressing these complexities through targeted research and intervention is crucial for reducing health disparities and fostering a more equitable healthcare landscape.

Citation Format: Christopher Wu, Zhixing Song, Ramsha Akhund, Chandler McLeod, Lauren Wood, Herbert Chen, J. Bart Rose, Smita Bhatia, Andrea Gillis. Weaving equity into the fabric of health: A deep dive into race, social determinants of health and facility type in pancreatic adenocarcinoma care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3946.