Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
J Surg Oncol. 2023 Jul;128(1):155-166. doi: 10.1002/jso.27257. Epub 2023 Mar 28.
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.
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.
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.
As technology dependence has increased, inequities in digital access should be targeted as a contributor to surgical oncologic disparities.
现代互联网接入和技术的使用极大地影响了外科护理的各个方面，但它们与胃肠道癌（GIC）结果的关联仍未得到明确界定。我们试图开发一种新的、自适应的数字不平等指数（DII）工具，以量化获取数字资源的能力，评估“数字不平等”对 GIC 护理和预后的影响。
从监测、流行病学和最终结果计划数据库中确定了 2013 年至 2017 年间患有胃肠道恶性肿瘤的成年（20 岁以上）患者。DII 是根据来自美国社区调查和联邦通信委员会的 17 个普查区水平变量计算得出的。变量分为基础设施接入（即电子设备拥有情况、宽带类型、互联网提供商可用性、收入-宽带订阅比例）或社会人口统计学（即教育、收入、残疾状况），在所有美国县中进行排名，然后平均为一个综合得分。使用多项逻辑回归和线性回归评估 DII 与手术接受、分期、监测期和生存时间之间的关系。
在 287228 名患者中，DII 增加与晚期疾病的几率增加相关（肝最高比值比[OR]：1.08，95%置信区间[CI]：1.05-1.10），接受手术的几率降低（肝最低 OR：0.94，95%CI：0.93-0.96）。DII 较高与术后监测时间缩短（肝最大减少-20.4%）和总生存时间缩短（胰腺最大减少-16.0%）相关。社会人口统计学和基础设施接入因素对监测时间差异的贡献相等，而基础设施接入因素对 GIC 类型的生存差异的贡献更大。
随着对技术的依赖程度增加，应将数字获取方面的不平等视为手术肿瘤学差异的一个促成因素。
