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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2020

01-02-2020 | Cholangiocarcinoma | Health Services Research and Global Oncology

Size and Importance of Socioeconomic Status-Based Disparities in Use of Surgery in Nonadvanced Stage Gastrointestinal Cancers

Authors: Douglas S. Swords, MD, MS, Sean J. Mulvihill, MD, Benjamin S. Brooke, MD, PhD, Matthew A. Firpo, PhD, Courtney L. Scaife, MD

Published in: Annals of Surgical Oncology | Issue 2/2020

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Abstract

Background

The size and importance of socioeconomic status (SES)-based disparities in use of surgery for non-advanced stage gastrointestinal (GI) cancers have not been quantified.

Methods

The exposure in this study of patients age 18–80 with one of nine non-advanced stage GI cancers in the 2007–2015 SEER database was a census tract-level SES composite. Multivariable models assessed associations of SES with use of surgery. Causal mediation analysis was used to estimate the proportion of survival disparities in SES quintiles 1 versus 5 that were mediated by disparities in use of surgery.

Results

Lowest SES quintile patients underwent surgery at significantly lower rates than highest quintile patients in each cancer. SES-based disparities in use of surgery were large and graded in esophagus adenocarcinoma, intrahepatic and extrahepatic cholangiocarcinoma, and pancreatic adenocarcinoma. Smaller but clinically relevant disparities were present in stomach, ampulla, and small bowel adenocarcinoma, whereas disparities were small in colorectal adenocarcinoma. Five-year all-stage overall survival (OS) was correlated with the size of disparities in use of surgery in SES quintiles 1 versus 5 (r = − 0.87; p = 0.003). Mean OS was significantly longer (range 3.5–8.9 months) in SES quintile 5 versus 1. Approximately one third of SES-based survival disparities in poor prognosis GI cancers were mediated by disparities in use of surgery. The size of disparities in use of surgery in SES quintiles 1 versus 5 was correlated with the proportion mediated (r = 0.98; p < 0.001).

Conclusions

Low SES patients with poor prognosis GI cancers are at substantial risk of undertreatment. Disparities in use of surgery contribute to diminished survival.
Appendix
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Metadata
Title
Size and Importance of Socioeconomic Status-Based Disparities in Use of Surgery in Nonadvanced Stage Gastrointestinal Cancers
Authors
Douglas S. Swords, MD, MS
Sean J. Mulvihill, MD
Benjamin S. Brooke, MD, PhD
Matthew A. Firpo, PhD
Courtney L. Scaife, MD
Publication date
01-02-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07922-7

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