Khani Masoud, Assadi Shalmani Mohammad, Taleban Amirsajjad, Tsai Susan, Nataliansyah Mochamad, Aldakkak Mohammed, Luo Jake
Health Informatics Program, Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United State of America.
Division of Surgical Oncology, Department of Surgery, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United State of America.
PLoS One. 2025 May 7;20(5):e0320518. doi: 10.1371/journal.pone.0320518. eCollection 2025.
Pancreatic cancer carries a dismal prognosis, with socioeconomic factors significantly impacting patient outcomes. This study investigates the influence of socioeconomic determinants on access to specialized pancreatic cancer care and utilization rates in southeast Wisconsin.
We analyzed a dataset of 5,847 pancreatic cancer patients from the Froedtert & the Medical College of Wisconsin health system (2000-2023). Patient demographics were compared to the broader health system population. Utilization of specialized pancreatic cancer care was calculated for each patient's zip code of residence. Linear and multivariate regression analyses were conducted to assess the association between socioeconomic factors (white population, income, education, insurance, Area Deprivation Index) and zip code-level utilization rates.
Pancreatic cancer patients were older (mean age 66.3 vs. 46.5 years), predominantly male (52.7%), and disproportionately White (83.2% vs 63.6%) compared to the general population. Notably, patients residing in zip codes with the lowest median household income (<$42,000) had a 0.15% utilization rate, while those in the wealthiest areas (>$87,000) showed a 0.14% rate. Interestingly, utilization dipped to its lowest point (0.068%) in areas with median incomes between $53,100-$59,300. Initial analysis suggested that higher education levels, private insurance, and higher median incomes were linked to increased utilization. However, after accounting for other factors, only the Area Deprivation Index (ADI) and the percentage of the White population remained significant predictors. Specifically, a one-unit increase in ADI (indicating greater neighborhood disadvantage) was associated with a 0.0015% decrease in specialized care utilization (p < 0.05). Similarly, a 1% increase in the White population within a zip code was linked to a 0.0014% reduction in utilization (p < 0.05).
Our findings reveal that neighborhood-level socioeconomic disadvantage, as captured by the ADI, is a strong independent predictor of reduced access to specialized pancreatic cancer care in southeast Wisconsin. Furthermore, factors such as education level, income, and insurance status are significantly associated with increased utilization of these vital services. These results underscore the urgent need for targeted interventions to address these inequities and ensure that all pancreatic cancer patients have equal access to potentially life-saving care, regardless of their socioeconomic background.
胰腺癌的预后很差，社会经济因素对患者的治疗结果有重大影响。本研究调查了社会经济决定因素对威斯康星州东南部获得胰腺癌专科护理的机会和利用率的影响。
我们分析了来自弗罗伊德特医院和威斯康星医学院医疗系统（2000 - 2023年）的5847例胰腺癌患者的数据集。将患者的人口统计学特征与更广泛的医疗系统人群进行比较。计算了每位患者居住邮政编码区域的胰腺癌专科护理利用率。进行线性和多变量回归分析，以评估社会经济因素（白人人口、收入、教育程度、保险、地区贫困指数）与邮政编码区域利用率之间的关联。
与普通人群相比，胰腺癌患者年龄更大（平均年龄66.3岁对46.5岁），男性占主导（52.7%），白人比例过高（83.2%对63.6%）。值得注意的是，居住在家庭收入中位数最低（<$42,000）邮政编码区域的患者利用率为0.15%，而在最富裕地区（>$87,000）的患者利用率为0.14%。有趣的是，在收入中位数为53,100 - 59,300美元的地区，利用率降至最低点（0.068%）。初步分析表明，较高的教育水平、私人保险和较高的收入中位数与利用率增加有关。然而，在考虑其他因素后，只有地区贫困指数（ADI）和白人人口百分比仍然是显著的预测因素。具体而言，ADI增加一个单位（表明邻里劣势更大）与专科护理利用率降低0.0015%相关（p < 0.05）。同样，邮政编码区域内白人人口增加1%与利用率降低0.0014%相关（p < 0.05）。
我们的研究结果表明，ADI所反映的邻里层面的社会经济劣势是威斯康星州东南部获得胰腺癌专科护理机会减少的一个强有力的独立预测因素。此外，教育水平、收入和保险状况等因素与这些重要服务的利用率增加显著相关。这些结果强调了迫切需要采取有针对性的干预措施来解决这些不平等问题，并确保所有胰腺癌患者，无论其社会经济背景如何，都能平等地获得可能挽救生命的护理。
