Investigating disparities: The effect of social environment on pancreatic cancer survival
| Autor: | Elizabeth Handorf, Kristen Sorice, David Madnick, Shannon M. Lynch, Namrata Vijayvergia, Lavanya Nagappan, Matthew Moccia, Khadija Cheema, Efrat Dotan, Yinuo Yin |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 37:208-208 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2019.37.4_suppl.208 |
| Popis: | 208 Background: Incidence rates of pancreatic adenocarcinoma (PAC) are higher in Black compared to White patients (pts). Beyond race, exposure to poor neighborhoods or social environments also contribute to cancer disparities. However, social environmental effects on PAC are not well-studied. Social environment is defined as: 1) a neighborhood’s socioeconomic conditions (SES; i.e. a combination of education, income, poverty and employment levels); 2) racial segregation (RS) or the degree of isolation/separation of race/ethnic groups in a neighborhood. The goal of our study is to investigate whether poor social environments impact survival in a clinic population with metastatic PAC. Methods: Neighborhood SES and RS measures were derived from US census data (2011-2015) at the census tract level, which is a smaller geographic area than a county. Patient (pt) addresses were used to generate a geocode that identifies the census tract or neighborhood in which a pt lives. We joined medical records of PAC pts (n = 374; diagnosed 2010-2016 at Fox Chase Cancer Center) to neighborhood measures via the geocode. Pt variables included in the analysis were: age, sex, race, marital status, treatment, PAC family history, stage, Jewish ancestry, tobacco use and Charlson comorbidity index. Multivariable cox proportional hazards models with cluster adjustments were used and variables with p-values < 0.05 were considered significant. Results: 342 PAC deaths occurred and median survival was 12m. 81% of pts were White; < 40% resided in poor social environments (i.e. low SES or high RS). In multivariable analyses stratified by RS, median survival was lower in pts from high RS (11m) vs low RS areas (13m); however, this difference was not significant (p = 0.27). Variable effects differed by high/low RS. In high RS areas, sex, surgery, chemo, diabetes and neighborhood SES were significant predictors of survival; in low RS areas, surgery, chemo, radiation, PAC family history, tobacco use, Jewish ancestry and race were significant. Conclusions: While social environment did not appear to significantly affect survival time in metastatic pts, its potential moderating (interaction) effects on variable associations with PAC warrant further investigation. |
| Databáze: | OpenAIRE |
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