Department of Surgery, University of Texas at Southwestern Medical Center, Dallas, TX, United States.
Department of Mathematics, University of Texas at Dallas, Richardson, TX, United States.
Am J Surg. 2023 Oct;226(4):515-522. doi: 10.1016/j.amjsurg.2023.06.013. Epub 2023 Jun 8.
Fragmentation of care and distance traveled are classically surrogates for poor access to care, but little is known about how social determinants of health interact with travel burden to affect survival for patients with pancreatic cancer (PC). We sought to characterize the individual and composite impact of these factors.
20769 patients treated for PC between 2005 and 2019 in the Texas Cancer Registry were included. The Area Deprivation Index and Poverty Index were used to quantify social determinants of health. Survival analyses were performed at 2 years as well as subgroup analysis on patients with the greatest travel burden.
Improved survival was associated with FC (HR 0.74, CI 0.71-0.77) and distance from an accredited cancer center (Quartile 4 HR 0.90, CI 0.81-1.00). High ADI led to worse outcomes while low ADI led to improved outcomes with increasing travel burden.
This data shows a complex relationship between travel burden and survival for patients with pancreatic cancer where stratifying by area deprivation reveals divergent outcomes and the potential to exacerbate disparities.
医疗服务碎片化和就诊距离是医疗服务可及性差的典型替代指标，但对于健康的社会决定因素如何与旅行负担相互作用，从而影响胰腺癌（PC）患者的生存，人们知之甚少。我们旨在描述这些因素的个体和综合影响。
在德克萨斯癌症登记处，2005 年至 2019 年间共纳入 20769 例接受 PC 治疗的患者。使用区域贫困指数和贫困指数来量化健康的社会决定因素。在 2 年时进行生存分析，并对旅行负担最大的患者进行亚组分析。
生存改善与 FC（HR 0.74，CI 0.71-0.77）和距离认可癌症中心的距离（四分位距 4 HR 0.90，CI 0.81-1.00）相关。高 ADI 导致结局较差，而低 ADI 导致随着旅行负担的增加而改善结局。
该数据显示了胰腺癌患者的旅行负担与生存之间的复杂关系，通过按区域贫困程度进行分层，可以揭示出不同的结果，并有可能加剧差异。
