The Influence of Area Deprivation Index on Surgical Outcomes in Pancreas Cancer

Background: Surgical resection for pancreas ductal adenocarcinoma (PDAC) remains the mainstay of treatment. Regardless of enhanced survival rates, disparities in patient outcomes and experiences driven by the social determinants of health (SDH) persist. The area deprivation index (ADI) comprises 17 indicators related to education, employment, housing-quality, and poverty. We sought to examine the impact of ADI on surgical outcomes of PDAC patients.

Methods: Patients who underwent pancreatoduodenectomy or distal pancreatectomy for PDAC between January 2011 and December 2022 were identified. ADI was calculated using patient zip codes and categorized into quartiles, with the highest indicating the most marginalized. The primary outcome was loss to follow-up after surgical resection. To account for confounders, a competing risk multivariable regression analysis was used.

Results: A total of 1001 patients had a mean age of 66.6 (±9.64), with 46.3% (n = 463) of patients being female. A majority, 94.6% (n = 947), identified as white, and 64.1% (n = 641) had at least a college degree. The median length of follow-up after surgery was 1.8 years (interquartile range: 0.9-3.5). Multivariable analysis adjusting for competing risk of death, showed that patients who are least marginalized are 1.57 times more likely to have their follow-up than those most marginalized (hazard ratio: 1.57, 95% confidence interval: 1.08-2.29, p = 0.017).

Conclusion: SDH impact many aspects of patient's care including a higher risk of loss to follow-up for marginalized patients after surgery for PDAC. Future efforts should seek to identify and lower barriers faced by marginalized patients with system-level changes to ensure equitable access.