Hepatopancreaticobiliary cancer outcomes are associated with county-level duration of poverty

Lima, Henrique A.; Woldesenbet, Selamawit; Hamad, Ahmad; Alaimo, Laura; Moazzam, Zorays; Endo, Yutaka; Shaikh, Chanza; Azap, Lovette; Munir, Muhammad Musaab; Resende, Vívian; Pawlik, Timothy M.

doi:10.1016/j.surg.2023.01.001

Cited by 4 publications

(8 citation statements)

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“…29 Our research group has recently reported on the association of county-level poverty duration relative to individuallevel cancer outcomes. 10 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.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 To this point, PP can have a dramatic and deep-rooted effect on access to healthcare. 9,10 The current study was important because we specifically examined the interplay between PP and the ability to access advanced surgical care such as MIS among patients with HPB cancer. Of note, patients who lived in counties with prolonged exposure to poverty over time had more limited access to MIS.…”

Section: Discussionmentioning

confidence: 99%

“…County‐level duration of poverty was assessed from the American Community Survey and the U.S. Department of Agriculture. Patients diagnosed with hepatocellular carcinoma (HCC), intrahepatic or extrahepatic cholangiocarcinoma (ICC and ECC, respectively), gallbladder cancer (GC), and pancreatic ductal adenocarcinoma (PDAC) were identified using ICD‐9/10 codes 10 . Individuals with missing data on race/ethnicity, type of surgery, clinicopathological stage, cause of death, county‐level poverty status, previous cancer history, diagnosis on autopsy, or death certificate alone were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…In fact, a patient's unique demographic and neighborhood characteristics may determine access to cancer care 8 . To quantify SDOH, several publicly accessible, evidence‐based metrics have been developed, including persistence of poverty (PP), which may be associated with reduced access to surgical treatment, achievement of an postoperative course, and worse cancer‐specific survival 9,10 . PP is defined by the US Department of Agriculture (USDA) as counties in which more than 20% of residents live below the federal poverty threshold for four consecutive decades 11,12 …”

Section: Introductionmentioning

confidence: 99%

“…Given the importance of understanding the role of SDOH, and persistent poverty (PP) in influencing surgical outcomes, we sought to investigate the association of county‐level duration of poverty with access to MIS among patients with HPB cancer 13 . In addition, the impact of PP on the likelihood to achieve an “optimal” textbook outcome (TO) following MIS was defined in a nationally representative cohort.…”

Section: Introductionmentioning

confidence: 99%

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Persistent poverty impacts access to minimally invasive surgery among patients with hepatopancreatobiliary cancer

Rawicz‐Pruszyński

Woldesenbet

Endo

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesMinimally invasive surgery (MIS) has been successfully adopted in hepatopancreatobiliary (HPB) cancer, and has been associated with improved perioperative and comparable oncological outcomes. We sought to define the impact of county‐level duration of poverty on access to MIS and clinical outcomes among patients with HPB cancer undergoing surgical treatment.Materials and MethodsData on patients diagnosed with HPB cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare data (2010–2016). County‐level poverty data were obtained from the American Community Survey and the U.S. Department of Agriculture, and categorized into three groups: never high poverty (NHP), intermittent high poverty (IHP), and persistent poverty (PP). Multivariable regression was used to assess the relationship between PP and MIS.ResultsAmong 8098 patients, 82% (n = 664) resided in regions with NHP, 13.6% (n = 1104) resided in regions with IHP, and 4.4% (n = 350) resided in regions with PP. Median age at the diagnosis was 71 years (interquartile range [IQR]: 67–77). Patients from IHP and PP counties had lower odds of undergoing MIS (IHP/PP vs. NHP, odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.36–0.96, p = 0.034) and being discharged home (IHP/PP vs. NHP, OR: 0.64, 95% CI: 0.43–0.99, p = 0.043), as well as a higher risk of 1‐year mortality (IHP/PP vs. NHP, HR: 1.51, 95% CI: 1.036–2.209, p = 0.032) compared with patients residing in NHP counties.ConclusionsDuration of county‐level poverty was associated with lower receipt of MIS and unfavorable clinical and survival outcomes among patients with HPB cancer. There is a need to improve access to modern surgical treatment options among vulnerable, PP populations.

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Section: Discussionmentioning

confidence: 99%