Hepatopancreaticobiliary cancer outcomes are associated with county-level duration of poverty
Surgery (United States)
Background: Socioeconomic status can often dictate access to timely surgical care and postoperative outcomes. We sought to analyze the impact of county-level poverty duration on hepatopancreaticobiliary cancer outcomes. Methods: Patients diagnosed with hepatopancreaticobiliary cancer were identified from the Surveillance, Epidemiology, and End Results-Medicare 2010 to 2015 database linked with county-level poverty from the American Community Survey and the US Department of Agriculture between 1980 to 2010. Counties were categorized as never high-poverty, intermittent high-poverty, and persistent poverty. Hierarchical generalized linear models and accelerated failure time models with Weibull distribution were used to assess diagnosis, treatment, textbook outcomes, and survival. Results: Among 41,077 patients, 1,758 (4.3%) lived in persistent poverty. Counties exposed to greater durations of poverty had increased proportions of non-Hispanic Black patients (never high-poverty: 7.6%, intermittent high-poverty: 20.4%, persistent poverty: 23.2%), uninsured patients (never high-poverty: 0.5%, intermittent high-poverty: 0.5%, persistent poverty: 0.9%), and patients with a rural residence (never high-poverty: 0.6%, intermittent high-poverty: 2.4%, persistent poverty: 11.5%). Individuals residing in persistent poverty had lower odds of undergoing resection (odds ratio 0.82, 95% confidence interval 0.66–0.98), achieving textbook outcomes (odds ratio 0.54, 95% confidence interval 0.34–0.84), and increased cancer-specific mortality (hazard ratio 1.07, 95% CI 1.00–1.15) (all P < .05). Non-Hispanic Black patients were less likely to present with early-stage disease (odds ratio 0.86, 95% confidence interval 0.79–0.95) and undergo surgical treatment (odds ratio 0.58, 95% confidence interval 0.52–0.66) compared to non-Hispanic White patients (both P < .01). Notably, non-Hispanic White patients in persistent poverty were more likely to present with early-stage disease (odds ratio 1.30, 95% confidence interval 1.12–1.52) and undergo surgery for localized disease (odds ratio 1.36, 95% confidence interval 1.06–1.74) compared to non-Hispanic Black patients in never high-poverty (both P < .05). Conclusion: Duration of poverty was associated with lower odds of receipt of surgical treatment, achievement of textbook outcomes, and worse cancer-specific survival. Non-Hispanic Black patients were at particular risk of suboptimal outcomes, highlighting the impact of structural racism independent of socioeconomic status.
Lima, H., Woldesenbet, S., Hamad, A., Alaimo, L., Moazzam, Z., Endo, Y., Shaikh, C., Azap, L., Munir, M., Resende, V., & Pawlik, T. (2023). Hepatopancreaticobiliary cancer outcomes are associated with county-level duration of poverty. Surgery (United States) https://doi.org/10.1016/j.surg.2023.01.001