Khalil Mujtaba, Woldesenbet Selamawit, Shaw Shreya, Altaf Abdullah, Zindani Shahzaib, Rashid Zayed, Thammachack Razeen, Husain Syed, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Ann Surg Oncol. 2025 Jul 8. doi: 10.1245/s10434-025-17764-1.
Historical discriminatory policies, such as residential redlining, along with current socioeconomic status, may impact gastrointestinal (GI) cancer care. We sought to investigate how evolving neighborhood characteristics impact the diagnosis and treatment of GI cancer.
Individuals who were diagnosed with GI cancer were identified using the Surveillance Epidemiology and End Results (SEER)-Medicare linked database. Neighborhood socioeconomic trajectories were determined using historical redlining grades and contemporary social vulnerability index scores. These trajectories were categorized as advantaged stable (chronically affluent neighborhoods), advantaged reduced (neighborhoods with declining affluence), disadvantaged stable (neighborhoods with chronic deprivation), and disadvantaged reduced (neighborhoods with declining deprivation). Multivariable regression was utilized to examine the association between neighborhood trajectory and stage at diagnosis, cancer-directed treatment, and surgical outcomes.
Among 15,118 individuals, 30.5% (n = 4608) resided in advantaged stable neighborhoods, 44.5% (n = 6727) in disadvantaged reduced neighborhoods, 2.96% (n = 448) in advantaged reduced neighborhoods, and 22.1% (n = 3335) in disadvantaged stable neighborhoods. Of note, individuals living in disadvantaged stable neighborhoods were less likely to undergo surgery (55.8% vs. 59.2%), receive chemotherapy (56.7% vs. 60.3%), and achieve a textbook outcome (TO) following surgery (41.3% vs. 51.3%) (all p < 0.001). On multivariable analyses, individuals living in disadvantaged stable neighborhoods had higher odds of being diagnosed at an advanced stage (OR 1.29, 95% CI 1.18-2.42) and lower odds of receiving chemotherapy (OR 0.67, 95% CI 0.58-0.76) and achieving a TO (OR 0.68, 95% CI 0.59-0.77).
Individuals living in disadvantaged stable neighborhoods have advanced stages at diagnosis and experience poorer surgical outcomes. There is an urgent need for targeted interventions and policies to address structural inequities and ensure health equity.
诸如居住区分级这样的历史歧视性政策，以及当前的社会经济状况，可能会影响胃肠道（GI）癌症的治疗。我们试图研究不断变化的社区特征如何影响GI癌症的诊断和治疗。
使用监测、流行病学和最终结果（SEER）-医疗保险链接数据库确定被诊断为GI癌症的个体。利用历史居住区分级和当代社会脆弱性指数得分确定社区社会经济轨迹。这些轨迹被分类为优势稳定型（长期富裕社区）、优势降低型（富裕程度下降的社区）、劣势稳定型（长期贫困社区）和劣势降低型（贫困程度下降的社区）。采用多变量回归分析来研究社区轨迹与诊断分期、癌症导向治疗及手术结果之间的关联。
在15118名个体中，30.5%（n = 4608）居住在优势稳定型社区，44.5%（n = 6727）居住在劣势降低型社区，2.96%（n = 448）居住在优势降低型社区，22.1%（n = 3335）居住在劣势稳定型社区。值得注意的是，居住在劣势稳定型社区的个体接受手术的可能性较小（55.8%对59.2%），接受化疗的可能性较小（56.7%对60.3%），手术后达到教科书式结果（TO）的可能性较小（41.3%对51.3%）（所有p < 0.001）。在多变量分析中，居住在劣势稳定型社区的个体在晚期被诊断的几率更高（OR 1.29，95% CI 1.18 - 2.42），接受化疗的几率更低（OR 0.67，95% CI 0.58 - 0.76），达到TO的几率更低（OR 0.68，95% CI 0.59 - 0.77）。
居住在劣势稳定型社区的个体在诊断时处于晚期，手术结果较差。迫切需要有针对性的干预措施和政策来解决结构性不平等问题，确保健康公平。
