The impact of sociodemographic characteristics on gastric cancer outcomes: A retrospective review of a large single center study.

Abstract

172 Background: Gastric cancer (GC) remains a pervasive condition in the US with high morbidity and mortality. Race/ethnicity, lack of insurance, and poverty may all be contributing to this burden, especially in select populations. We evaluated the impact of these sociodemographic factors on GC outcomes at a hospital with high immigrant-patient populations. Methods: We conducted a retrospective study to identify patients diagnosed with GC between year 2010 and 2019. Data obtained from our institution database regarding patients' sociodemographic factors, including age, gender, race/ethnicity, insurance status and type, and neighborhood socioeconomic status. Likewise, information on tumor histology, anatomic location, and stage were also obtained. Kaplan-Meier analysis was used to plot survival curves and analyze the impact of insurance on survival outcome. Results: One hundred eleven patients were analyzed in this study, with a male-to-female ratio of 1.26:1. The median age at the time of GC diagnosis was 52.9 (range 27-87) years, with median survival time (±SD, range) of 12.7 (±17.7, 0.25-84) months. Most patients (69.4%) were uninsured—out of which 76.7% presented with advanced-stage disease. Among those, the majority (70.3%) were Hispanic, and 60.4% were non-U.S. citizens. The most common tumor histology was diffuse-type adenocarcinoma in 55% of patients. Patients insured were on public coverage (Medicaid), private insurance, and Medicare at 11.7%, 9.9%, and 9.0%, respectively. In terms of survival, lack of insurance (p = 0.012) and Medicaid insurance (p = 0.046) were associated with the worst survival outcomes in GC patients. Conclusions: Our study reflects the trends in GC outcomes distinctly linked to significant sociodemographic disparities. Patients who lack insurance coverage had the worst survival outcomes. Therefore, efforts such as increasing healthcare access for this population-type at risk of sociodemographic incongruities may enhance outcomes and are crucial in fighting GC.

Impact of Insurance Status on Late-Stage Disease Presentation and Disease-Specific Survival among US Patients With Gastric Cancer

“…Findakly et al conducted a large single-institution retrospective cohort study evaluating the impact of sociodemographic characteristics on GC outcomes among 111 patients with GC, demonstrating that lack of insurance or having Medicaid were associated with significantly worse survival outcomes. 20 However, most of the patients in the study were uninsured, where fewer than 30% of them had any form of insurance. Another study by Jang et al, aimed to evaluate the association of medical insurance status of 333 Korean patients with GC and their survival after gastrectomy, reporting that the medical aid group had a similar survival rate compared to the Medicaid/Uninsured group.…”

“…Previous research on the association of insurance status and GC outcomes have shown worse survival outcomes while others have documented no difference in the rate of survival. [19][20][21] However, the sample sizes of these studies may not have been adequately powered to confidently assert these conclusions. In addition, none of these studies focused on the worst histologic type of GC, gastric adenocarcinoma.…”

“…19 Another study conducted by Findakly et al also reported worse survival outcomes in GC patients who were on Medicaid and those without insurance compared to those privately insured. 20…”

“…19 Another study conducted by Findakly et al also reported worse survival outcomes in GC patients who were on Medicaid and those without insurance compared to those privately insured. 20 The stage of GC at diagnosis constitutes another risk factor affecting survival outcomes in cancer patients. It is not surprising that systemic barriers to health insurance and access to healthcare can delay preventive screening, diagnosis, and treatment for patients with GC.…”

Variation in Treatment Patterns of Patients with Early-Onset Gastric Cancer

“…In the Netherlands, younger age and higher socioeconomic status (SES) were independent factors for receiving treatment in patients with esophageal and gastric cancer [ 38 , 39 ]. Notably, patients with gastric cancer who lack insurance have been shown to have worse survival outcomes and receive less therapy compared to insured patients [ 40 , 41 ]. Insurance status plays a role in the type of treatment patients can receive (as well as where they can receive it).…”