农村性、社会经济地位和种族与胰腺癌手术治疗和生存的关系。
Association of rurality, socioeconomic status, and race with pancreatic cancer surgical treatment and survival.
机构信息
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH, USA.
Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
出版信息
J Natl Cancer Inst. 2023 Oct 9;115(10):1171-1178. doi: 10.1093/jnci/djad102.
BACKGROUND
Pancreatectomy is a necessary component of curative intent therapy for pancreatic cancer, and patients living in nonmetropolitan areas may face barriers to accessing timely surgical care. We evaluated the intersecting associations of rurality, socioeconomic status (SES), and race on treatment and outcomes of Medicare beneficiaries with pancreatic cancer.
METHODS
We conducted a retrospective cohort study, using fee-for-service Medicare claims of beneficiaries with incident pancreatic cancer (2016-2018). We categorized beneficiary place of residence as metropolitan, micropolitan, or rural. Measures of SES were Medicare-Medicaid dual eligibility and the Area Deprivation Index. Primary study outcomes were receipt of pancreatectomy and 1-year mortality. Exposure-outcome associations were assessed with competing risks and logistic regression.
RESULTS
We identified 45 915 beneficiaries with pancreatic cancer, including 78.4%, 10.9%, and 10.7% residing in metropolitan, micropolitan, and rural areas, respectively. In analyses adjusted for age, sex, comorbidity, and metastasis, residents of micropolitan and rural areas were less likely to undergo pancreatectomy (adjusted subdistribution hazard ratio = 0.88 for rural, 95% confidence interval [CI] = 0.81 to 0.95) and had higher 1-year mortality (adjusted odds ratio = 1.25 for rural, 95% CI = 1.17 to 1.33) compared with metropolitan residents. Adjustment for measures of SES attenuated the association of nonmetropolitan residence with mortality, and there was no statistically significant association of rurality with pancreatectomy after adjustment. Black beneficiaries had lower likelihood of pancreatectomy than White, non-Hispanic beneficiaries (subdistribution hazard ratio = 0.80, 95% CI = 0.72 to 0.89, adjusted for SES). One-year mortality in metropolitan areas was higher for Black beneficiaries (adjusted odds ratio = 1.15, 95% CI = 1.05 to 1.26).
CONCLUSIONS
Rurality, socioeconomic deprivation, and race have complex interrelationships and are associated with disparities in pancreatic cancer treatment and outcomes.
背景
胰腺癌切除术是胰腺癌有治愈可能的治疗方法中的必要组成部分，而居住在非大都市地区的患者可能在获得及时手术治疗方面面临障碍。我们评估了农村地区、社会经济地位（SES）和种族对医疗保险受益人的胰腺癌治疗和结局的相互关联的影响。
方法
我们进行了一项回顾性队列研究，使用了 2016-2018 年患有胰腺癌的医疗保险受益人的费用支付数据。我们将受益人的居住地点分为大都市、中小城市或农村。SES 的衡量标准是医疗保险-医疗补助双重资格和区域贫困指数。主要研究结果是接受胰腺癌切除术和 1 年死亡率。采用竞争风险和逻辑回归评估暴露-结局关联。
结果
我们确定了 45915 名患有胰腺癌的受益人群，其中 78.4%、10.9%和 10.7%分别居住在大都市、中小城市和农村地区。在调整了年龄、性别、合并症和转移后，居住在中小城市和农村地区的人群接受胰腺癌切除术的可能性较低（调整后的亚分布危险比为农村地区为 0.88，95%置信区间为 0.81 至 0.95），1 年死亡率较高（调整后的优势比为农村地区为 1.25，95%置信区间为 1.17 至 1.33）与大都市居民相比。SES 衡量标准的调整减弱了非大都市居住与死亡率之间的关联，而在调整后，农村地区与胰腺癌切除术之间没有统计学意义上的关联。黑人受益人群接受胰腺癌切除术的可能性低于白人非西班牙裔受益人群（亚分布危险比为 0.80，95%置信区间为 0.72 至 0.89，调整 SES）。大都市地区黑人受益人群的 1 年死亡率较高（调整后的优势比为 1.15，95%置信区间为 1.05 至 1.26）。
结论
农村地区、社会经济贫困和种族之间存在复杂的相互关系，并与胰腺癌治疗和结局的差异有关。
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