Counting coins and cardiovascular catastrophes: The income–pancreas connection.
Authors: Raval Maharshi , Uttam Chandani Kanishka , Agrawal Siddharth Pravin , Siddiq Sajid , Nadeem Ahmed , Chintakuntlawar Ashish V. , Eldimllawi Ahmed Medhat 
Published: July 2024

e16342 Background: Pancreatic cancer poses a major challenge due to its high mortality rates and is known as one of the deadliest cancers. The increasing mortality in addition to the aggressive nature of the tumor may be due to major cardiovascular and cerebrovascular events (MACCE). The key to mitigating the risk of pancreatic cancer as well as MACCE, is primary prevention of common risk factors including tobacco use, obesity, dietary factors, alcohol use, and physical activity. Understanding that many of these factors are directly and indirectly influenced by income status, this study aims to explore the relationship between household income on MACCE in pancreatic cancer patients. Methods: Using ICD-10 codes, patients with pancreatic cancer were identified from National Inpatient Sample 2019 database. We included all-cause in-hospital mortality (ACIHM), acute myocardial infarction (AMI), arrythmia, cerebrovascular accident (CVA), and sudden cardiac death (SCD) as MACCE for the outcomes. Baseline characteristics including demographics, comorbidities; and MACCE outcomes were studied using chi-square for categorical or ANOVA for continuous data (statistical significance determined as p-value < 0.05) and results were stratified based on median household income quartiles. Results: Of the 114,235 patients identified with pancreatic cancer who were admitted to the hospital, 25% (28,570) belonged to the first income quartile ($1-47,999), 23.8% (27,235) belonged to the second income quartile ($48,000-60,999), 26.38% (30,135) belonged to the third income quartile ($61,000-81,999), and 24.76% (28,295) belonged to the fourth income quartile ($82,000+). When compared to the patients in the fourth quartile, the adjusted odds ratio (aOR) was found to be higher for all MACCE outcomes for patients in first quartile. The aOR for ACIHM in the first quartile was found to be 1.24 (95% CI 1.06-1.46, p = 0.006) as compared to patients in the fourth quartile. Additionally, the aOR for AMI, was found to be statistically significant in patients belonging to the first quartile at 1.30 (95% CI 1.01-1.70, p = 0.047). Similarly, the aORs for both arrhythmia and SCD were also higher in the population from the first quartile at 3.67 (95% CI 1.10-12.28, p = 0.03) and 1.45 (95% CI 1.01-2.09, p = 0.049). https://docs.google.com/document/d/1v84LyPoGL406_7SDxO1N-wKxwujSgFpf/edit?usp = sharing&ouid = 110330426831507953030&rtpof = true&sd = true. Conclusions: As compared to patients in fourth income quartile, the aOR was found to be higher for all MACCE outcomes for patients in the first income quartile, indicating a vast variation based on income strata. This hints towards a complex interplay of healthcare disparities including but not limited to difficult access to quality healthcare including subspecialities. Further research may be pertinent to explore the causes of this clear disparity to ensure equitable healthcare for all patient population.