Manisundaram Naveen V, Hu Chung-Yuan, Herb Joshua N, DiBrito Sandra R, Snyder Rebecca A, Uppal Abhineet, Chang George J
Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Ann Surg Oncol. 2025 May 31. doi: 10.1245/s10434-025-17555-8.
Social determinants of health play a significant role in the incidence, diagnosis, and treatment of cancers, contributing to healthcare disparities. However, the impact of facility-level factors on patient outcomes are often obscured. We aimed to determine whether hospitals serving the lowest-income patients have poorer overall survival outcomes.
We identified patients diagnosed with nonmetastatic colorectal, breast, gastric, and pancreatic cancers (2010-2019) using the National Cancer Database. Patient median income, estimated by residential zip code, was converted into linear mean scores (LMS), with aggregated scores compiled for each hospital. Hospitals were ranked according to average patient LMS and grouped by quartile, with the lowest quartile representing lowest-income-serving hospitals (LIH) and the top quartile denoting highest-income-serving hospitals (HIH).
A total of 833,874 patients were included for analysis, consisting of patients with colorectal (n = 379,423), breast (n = 389,852), pancreatic (n = 45,543) and gastric (n = 19,056) cancer. The 5-year overall survival (OS) was lower for patients receiving treatment for colorectal (67.6 versus 73.6%, p < 0.001), breast (81.9 versus 89.5%, p < 001), gastric (41.9 versus 56.0%, p < 0.001), and pancreatic (31.5 versus 42.1%, p < 0.001) cancer at LIH versus HIH, and this effect had a dose-dependent relationship with hospital income quartile. Within each hospital quartile, patients with higher income had decreased risk of death compared with those with lower income (p < 0.001).
Patients treated for colorectal, breast, gastric, and pancreatic cancer at LIH have worse survival than those at HIH. Income inequality contributes to differences in healthcare outcomes, and these differences are further compounded by the institution at which a patient receives care.
健康的社会决定因素在癌症的发病率、诊断和治疗中起着重要作用，导致了医疗保健方面的差异。然而，机构层面因素对患者预后的影响往往被掩盖。我们旨在确定为收入最低的患者提供服务的医院的总体生存结局是否更差。
我们使用国家癌症数据库确定了2010 - 2019年被诊断为非转移性结直肠癌、乳腺癌、胃癌和胰腺癌的患者。根据居住邮政编码估计的患者收入中位数被转换为线性平均得分（LMS），并为每家医院编制汇总得分。医院根据患者平均LMS进行排名，并按四分位数分组，最低四分位数代表为低收入患者服务的医院（LIH），最高四分位数表示为高收入患者服务的医院（HIH）。
共纳入833,874例患者进行分析，包括结直肠癌患者（n = 379,423）、乳腺癌患者（n = 389,852）、胰腺癌患者（n = 45,543）和胃癌患者（n = 19,056）。与HIH相比，LIH接受结直肠癌（67.6%对73.6%，p < 0.001）、乳腺癌（81.9%对89.5%，p < 0.001）、胃癌（41.9%对56.0%，p < 0.001）和胰腺癌（31.5%对42.1%，p < 0.001）治疗的患者5年总生存率较低，且这种影响与医院收入四分位数呈剂量依赖关系。在每个医院四分位数内，收入较高的患者与收入较低的患者相比死亡风险降低（p < 0.001）。
在LIH接受结直肠癌、乳腺癌、胃癌和胰腺癌治疗的患者的生存率低于在HIH接受治疗的患者。收入不平等导致了医疗保健结局的差异，而这些差异因患者接受治疗的机构而进一步加剧。
