The impact of digital inequities on gastrointestinal cancer disparities in the United States

Abstract

Background Modern‐day internet access and technology usage substantially impacts aspects of surgical care but remain ill‐defined for their associations with gastrointestinal‐cancer (GIC) outcomes. We sought to develop the Digital Inequity Index (DII), a novel, a self‐adapted tool to quantify access to digital resources, to assess the impact of “digital inequity” on GIC care and prognosis. Methods Adult (20+) patients with gastrointestinal malignancies between 2013 and 2017 were identified from the Surveillance, Epidemiology, and End Results Program database. DII was calculated based on 17 census‐tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure‐access (i.e., electronic device ownership, broadband type, internet provider availability, income‐broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked relative across all US counties, and then averaged into a composite score. The association between DII and surgery receipt, staging, surveillance period, and survival time were assessed with multiple logistic and linear regressions. Results Among 287 228 patients, increasing DII was associated with increased odds of late‐stage disease (highest odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.05–1.10 for hepatic) and decreased odds of receiving surgery (lowest OR: 0.94, 95% CI: 0.93–0.96 for hepatic). Higher DII was associated with shorter postoperative surveillance length (largest decrease −20.4% for hepatic) and overall survival length (largest decrease −16.0% for pancreatic). Sociodemographic and infrastructure‐access factors contributed equivalently to surveillance time disparities, while infrastructure‐access factors contributed more to survival disparities across GIC types. Conclusions As technology dependence has increased, inequities in digital access should be targeted as a contributor to surgical oncologic disparities.

Comparative Review on Cancer Pathology from Aberrant Histone Chaperone Activity

“…GIC encompasses a group of malignancies that affect the digestive system, including the esophagus, stomach, liver, pancreas, gallbladder, and intestines [ 49 ]. Globally, GIC accounts for significant morbidity and mortality, with stomach and colorectal cancers being among the top five causes of cancer-related deaths [ 50 ].…”

The associations of food environment with gastrointestinal cancer outcomes in the United States

“…With the advent of SDoH-based tools developed from the US Census, there have been increased efforts to understand the interaction of socioeconomic status, race/ethnicity, household composition, housing-transportation, as well as nontraditional factors of digital and internet accessibility on healthcare outcomes. [10][11][12] While relatively understudied, nutrition and food access may be a driving influence on the incidence, stage, treatment, as well as regionalization of patients with GIC. [13][14][15] To date, most data on nutrition and food access have included only a general, pan-oncologic investigation demonstrating disparities among obese-individuals across a wide range of patients.…”