Impact of socioeconomic status on presentation, treatment and outcomes of patients with pancreatic cancer
Publication: Journal of Comparative Effectiveness Research
Abstract
Objective: To assess the impact of socioeconomic status (SES) on the patterns of care and outcomes of patients with pancreatic cancer. Materials & methods: Surveillance, Epidemiology and End Results specialized SES registry has been accessed and patients with pancreatic cancer diagnosed (2000–2015) were evaluated. The following SES variables were included: employment percentage, percent of people above the poverty line, percent of people identified as working-class, educational level, median rent, median household value and median household income. Within this SES registry, patients were classified according to their census-tract SES into three groups (where group-1 represents the lowest SES category and group-3 represents the highest SES category). Multivariable logistic regression analysis was used to assess the impact of SES on access to surgical resection and multivariable Cox regression analysis was used to assess the impact of SES on pancreatic cancer-specific survival. Kaplan–Meier survival estimates were also used to compare overall survival (OS) outcomes according to SES. Results: A total of 83,902 pancreatic cancer patients were included in the current analysis. Within multivariable logistic regression analysis among patients with a localized/regional disease, patients with lower SES were less likely to undergo surgical resection for pancreatic cancer (odds ratio: 0.719; 95% CI: 0.673–0.767; p < 0.001). Among patients with a localized/regional disease who underwent surgical resection, patients with higher SES have better OS (median OS for group-3: 20.0 vs 17.0 months for group-1; p < 0.001). Moreover, patients with lower SES have worse pancreatic cancer-specific survival compared with patients with higher SES: (hazard ratio for group-1 vs group-3: 1.212; 95% CI: 1.135–1.295; p < 0.001). Conclusion: Poor neighborhood SES is associated with more advanced disease at presentation, less probability of surgical resection and even poorer outcomes after surgical resection.
Formats available
You can view the full content in the following formats:
References
Papers of special note have been highlighted as: • of interest
1.
Clegg LX, Reichman ME, Miller BA et al. Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study. Cancer Causes Control 20(4), 417–435 (2009).
2.
Link BG, Phelan JC. Understanding sociodemographic differences in health–the role of fundamental social causes. Am. J. Public Health 86(4), 471–473 (1996).
3.
Clegg LX, Reichman ME, Miller BA et al. Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study. Cancer Causes Control 20(4), 417–435 (2009).
4.
Abdel-Rahman O. Socioeconomic predictors of suicide risk among cancer patients in the United States: a population-based study. Cancer Epidemiol. 63, 101601 (2019).
5.
Saad AM, Turk T, Al-Husseini MJ, Abdel-Rahman O. Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer 18(1), 688–688 (2018).
6.
Shapiro M, Chen Q, Huang Q et al. Associations of socioeconomic variables with resection, stage, and survival in patients with early-stage pancreatic cancer. JAMA Surg. 151(4), 338–345 (2016).
7.
Kagedan DJ, Abraham L, Goyert N et al. Beyond the dollar: influence of sociodemographic marginalization on surgical resection, adjuvant therapy, and survival in patients with pancreatic cancer. Cancer 122(20), 3175–3182 (2016).
8.
Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence - SEER 18 Regs excluding AK (with additional treatment fields), Nov 2017 Sub (2000–2015) <Vintage 2015 Pops by Race/Origin Tract 2000/2010 Mixed Geographies> - Linked To Census Tract Attributes - Time Dependent (2000–2015) – SEER 18 (excl AK) Census 2000/2010 Geographies with Index Field Quantiles, National Cancer Institute, DCCPS, Surveillance Research Program, released June 2018, based on the November 2017 submission (2018). www.seer.cancer.gov
9.
Yost K, Perkins C, Cohen R, Morris C, Wright W. Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 12(8), 703–711 (2001).
10.
Yu M, Tatalovich Z, Gibson JT, Cronin KA. Using a composite index of socioeconomic status to investigate health disparities while protecting the confidentiality of cancer registry data. Cancer Causes Control 25(1), 81–92 (2014).
11.
Liu L, Deapen D, Bernstein L. Socioeconomic status and cancers of the female breast and reproductive organs: a comparison across racial/ethnic populations in Los Angeles County, California (United States). Cancer Causes Control 9(4), 369–380 (1998).
12.
Census Tract-level SES and Rurality Database (2000–2015) (2019). https://seer.cancer.gov/seerstat/databases/census-tract/index.html
13.
Murphy MM, Simons JP, Hill JS et al. Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer 115(17), 3979–3990 (2009).
14.
Permuth JB, Clark Daly A, Jeong D et al. Racial and ethnic disparities in a state-wide registry of patients with pancreatic cancer and an exploratory investigation of cancer cachexia as a contributor to observed inequities. Cancer Med. 8(6), 3314–3324 (2019).
15.
Cheung MC, Yang R, Byrne MM, Solorzano CC, Nakeeb A, Koniaris LG. Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? Cancer 116(3), 723–733 (2010).
16.
Zell JA, Rhee JM, Ziogas A, Lipkin SM, Anton-Culver H. Race, socioeconomic status, treatment, and survival time among pancreatic cancer cases in California. Cancer Epidemiol. Biomarkers Prev. 16(3), 546–552 (2007).
17.
Louwman WJ, Aarts MJ, Houterman S, van Lenthe FJ, Coebergh JW, Janssen-Heijnen ML. A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status. Br. J. Cancer 103(11), 1742–1748 (2010).
18.
van Roest MH, van der Aa MA, van der Geest LG, de Jong KP. the impact of socioeconomic status, surgical resection and type of hospital on survival in patients with pancreatic cancer. A population-based study in The Netherlands. PLoS ONE 11(11), e0166449 (2016).
19.
Henson KE, Fry A, Lyratzopoulos G, Peake M, Roberts KJ, McPhail S. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013–2014. Br. J. Cancer 118(10), 1382–1390 (2018).
20.
Greenland S, Morgenstern H. Ecological bias, confounding, and effect modification. Int. J. Epidemiol. 18(1), 269–274 (1989).
21.
Abdel-Rahman O. Treatment choices and outcomes of non-metastatic hepatocellular carcinoma patients in relationship to neighborhood socioeconomic status: a population-based study. Int. J. Clin. Oncol. 25(5), 861–866 (2020).
22.
Abdel-Rahman O. Outcomes of non-metastatic colon cancer patients in relationship to socioeconomic status: an analysis of SEER census tract-level socioeconomic database. Int. J. Clin. Oncol. 24(12), 1582–1587 (2019).
• Reviews the impact of socioeconomic status on the outcomes of nonmetastatic colon cancer.
23.
Abdel-Rahman O. Impact of NCI Socioeconomic Index on the outcomes of nonmetastatic breast cancer patients: analysis of SEER Census Tract-Level Socioeconomic Database. Clin. Breast Cancer 19(6), e717–e722 (2019).
Information & Authors
Information
Published In
Pages: 1233 - 1241
PubMed: 33275039
Copyright
© 2020 Future Medicine Ltd.
History
Received: 11 May 2020
Accepted: 30 September 2020
Published online: 4 December 2020
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Impact of socioeconomic status on presentation, treatment and outcomes of patients with pancreatic cancer. (2020) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2020-0079
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Omar Abdel-Rahman, Sunita Ghosh, Measuring the improvement in overall survival among patients with advanced gastroenteropancreatic neuroendocrine tumors over the past two decades, Scandinavian Journal of Gastroenterology, 10.1080/00365521.2026.2648052, (1-7), (2026).
- Omar Abdel-Rahman, Sunita Ghosh, Disparities in time to Treatment Initiation Among Patients with Major Types of Cancer in the United States, Journal of Racial and Ethnic Health Disparities, 10.1007/s40615-026-02847-w, (2026).
- Maite N.E. Liem, Mats D. Teeken, Mengyuan Ruan, George Molina, Geospatial variation in the treatment of medicare beneficiary pancreatic cancer patients: A SEER-Medicare cohort study, The American Journal of Surgery, 10.1016/j.amjsurg.2025.116684, 251, (116684), (2026).
- Abdullah Khalid, Ali Anjum Fazal, Manav Shah, Danielle DePeralta, Sepideh Gholami, Elliot Newman, Marcovalerio Melis, Matthew J. Weiss, Survival Disparities in Early‐Onset Pancreatic Cancer (EOPC): The Role of Socioeconomic Status and Healthcare Access, Journal of Surgical Oncology, 10.1002/jso.70148, 133, 3, (349-360), (2025).
- Devanshi D. Patel, Samantha Brashier, Andrew M. Fleming, Evan S. Glazer, Gabriela L. Aitken, Paxton V. Dickson, The Impact of Race and Socioeconomic Status on Management of Potentially Resectable Pancreatic Cancer: Analysis From a Metropolitan Area in the Southeast United States, The American Surgeon™, 10.1177/00031348251399190, 92, 5, (1498-1507), (2025).
- Alireza Hadipour, Sedighe Sadat Tabatabaei Far, Sahar Akrami, Bayati Mohsen, The role of political, economic and social factors on the burden of prevalent cancers in the world: A dynamic panel model, Payesh (Health Monitor) Journal, 10.61882/payesh.24.5.617, 24, 5, (617-625), (2025).
- Yoon Duk Hong, Angela B. Mariotto, Denise R. Lewis, Anne-Michelle Noone, Nadia Howlader, Steve Scoppa, Eric J. Feuer, Compliance With Recommendations of the Surveillance, Epidemiology, and End Results (SEER) Treatment Data Use Agreement, Medical Care, 10.1097/MLR.0000000000002218, 63, 12, (899-906), (2025).
- Shivam Chandra, Vivian Liang, Anthony V Coglianese, Steven R Bonomo, The Impact of Racial Disparities and Social Determinants of Health on Postoperative Outcomes After Pancreaticoduodenectomy (Whipple Procedure), Cureus, 10.7759/cureus.91855, (2025).
- Shreeja N. Patel, Joseph R. Habib, Daniel Brock Hewitt, Michael D. Kluger, Katherine Morgan, Ammar A. Javed, Christopher L. Wolfgang, Greg D. Sacks, The Impact of Social Determinants on Pancreatic Cancer Care in the United States, Cancers, 10.3390/cancers17121898, 17, 12, (1898), (2025).
- Rui He, Zhengnan Shen, Qiuping Chen, Haiyang Hu, Xin Ding, Zhenglong Zheng, Quansheng Feng, Baixue Li, Pancreatic cancer mortality in China from 2004 to 2021: an in-depth analysis of age, gender, and regional disparities, BMC Cancer, 10.1186/s12885-025-13863-0, 25, 1, (2025).
- See more