Association of healthcare delivery model with stage at diagnosis of pancreatic cancer.

Abstract

e23126 Background: Pancreatic cancer is a leading cause of cancer mortality in the U.S., with a 5-year relative survival rate of 13.3%. Prior studies suggest improved cancer outcomes within integrated healthcare systems compared with nonintegrated systems; however, the association between healthcare delivery model and stage at diagnosis for pancreatic cancer has not been assessed. We examined whether diagnosis within a vertically integrated healthcare system is associated with earlier stage at diagnosis in pancreatic cancer among a diverse patient population. Methods: We conducted a retrospective cohort study using the California Cancer Registry, identifying 12,187 insured patients diagnosed with pancreatic cancer in Southern California from 2015–2021. Patients were diagnosed in Kaiser Foundation (KF) Hospitals, part of a vertically integrated healthcare system, or in non-KF hospitals. Data included SEER summary stage at diagnosis and demographic characteristics (age, race and ethnicity, sex, and geocoded socioeconomic status). Multivariable logistic regression adjusted for these covariates assessed the association between hospital of diagnosis (KF vs non-KF) and stage at diagnosis (localized vs advanced). A subgroup analysis among KF members examined demographics associated with stage at diagnosis. Results: Among 12,187 patients, 3,194 (26.2%) were diagnosed within KF. The cohort was racially diverse: 3,080 (25.3%) Hispanic, 965 (7.9%) Black/African American, and 1,543 (12.7%) Asian/Pacific Islander patients. Overall, 2,128 (17.5%) patients presented with localized disease and 10,059 (82.5%) with advanced stage. Compared with diagnosis at non-KF hospitals, those diagnosed within KF had higher odds of localized stage at diagnosis (OR 1.15, 95% CI 1.03-1.28). In subgroup analyses by race and ethnicity, higher odds of presenting with localized disease were seen across patient groups, including Asian/Pacific Islander (OR 1.18; 95% CI 1.13 - 1.24), Black/African American (OR 1.36; 95% CI 1.29-1.43), Hispanic (OR 1.14; 95%CI 1.10 - 1.17), and non-Hispanic White (OR 1.13; 95% CI 1.11-1.16) when compared to their counterparts diagnosed at non-KF hospitals. In a subgroup analysis of patients within KF, Hispanic (OR 1.22; 95% CI 0.97-1.54) and Asian/Pacific Islander (OR 1.37; 95% CI 1.03-1.82) patients were at increased odds of being diagnosed with local disease compared to Non-Hispanic White individuals. Conclusions: Odds of localized stage at diagnosis in pancreatic cancer was greater in KF compared with diagnosis in non-integrated healthcare settings across a racially diverse patient population. Within KF, Asian/Pacific Islander patients had a statistically significant increased odds of being diagnosed with local disease. Further studies are warranted to elucidate mechanisms of how vertically integrated healthcare delivery models may facilitate earlier diagnosis of pancreatic cancer.