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Association between social determinants of health and delayed postoperative adjuvant therapy among patients undergoing resection of pancreatic cancer.
- Source :
-
Journal of surgical oncology [J Surg Oncol] 2024 Apr; Vol. 129 (5), pp. 850-859. Date of Electronic Publication: 2023 Dec 27. - Publication Year :
- 2024
-
Abstract
- Background and Objectives: Pancreatic cancer (PDAC) requires a multimodality approach. We sought to define the association between social determinants of health (SDOH) and delayed or nonreceipt of adjuvant chemotherapy (aCT) among patients undergoing PDAC resection.<br />Methods: Data on patients who underwent PDAC resection between 2014 and 2020 were identified from Medicare Standard Analytic Files and merged with the county-level social vulnerability index (SVI). Mediation analysis defined the association between SVI subthemes and aCT receipt.<br />Results: Among 24 078 patients, 47.7% received timely aCT, 17.7% received delayed aCT, and 34.6% did not receive any aCT. High SVI was associated with delay (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.10-1.34) and nonreceipt of aCT (OR 1.30, 95% CI 1.20-1.41) (both p < 0.05). 73.1% of the variation in timely aCT receipt was directly attributable to SVI, whereas 26.9% of the effect was due to indirect mediators including hospital volume (6.4%), length-of-stay (7.9%) and postoperative complications (12.6%). Socioeconomic status (delayed aCT: OR 1.25, 95% CI 1.13-1.38; nonreceipt aCT: OR 1.25, 95% CI 1.15-1.36) and household composition and disability (delayed aCT: OR 1.30, 95% CI 1.17-1.43; nonreceipt aCT: OR 1.19, 95% CI 1.09-1.29) were associated with receipt of aCT (both p < 0.001).<br />Conclusions: Most of the disparities in receipt of aCT after PDAC surgery are driven by underlying SDOH such as SVI.<br /> (© 2023 Wiley Periodicals LLC.)
Details
- Language :
- English
- ISSN :
- 1096-9098
- Volume :
- 129
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 38151795
- Full Text :
- https://doi.org/10.1002/jso.27571