Racial and socioeconomic disparities in stage at diagnosis and survival in pancreatic cancer: Analysis of SEER 17 data (1998–2017).

Abstract

e16338 Background: Pancreatic cancer is characterized by late stage diagnosis and high mortality. While racial and socioeconomic status (SES) disparities are known to affect cancer outcomes, their specific impact on pancreatic cancer stage distribution and survival requires further quantification. This study examined racial disparities in stage at diagnosis and survival using a large, population based cohort. Methods: We analyzed 158,308 pancreatic cancer cases from the SEER 17 registries (1998–2017). Race was categorized as White, Black, Asian or Pacific Islander (API), and American Indian/Alaska Native (AI/AN). Stage was classified as Localized, Regional, or Distant. SES was determined by median household income quintiles. Survival was assessed via Kaplan Meier analysis and multivariate Cox proportional hazards models adjusting for stage and SES. Results: Among 158,308 patients, stage at diagnosis differed significantly by race (χ² = 117.56, df = 8; p < 0.001), with most patients presenting with distant-stage disease. In unadjusted analyses, overall survival differed by race (log-rank p < 0.005). In multivariable Cox proportional hazards models adjusted for stage at diagnosis and socioeconomic status, survival differed across racial groups. Using White patients as the reference group, American Indian or Alaska Native patients had a higher risk of mortality, whereas Asian or Pacific Islander patients had a lower risk of mortality. Black patients did not have a statistically significant difference in mortality compared with White patients after adjustment. Stage at diagnosis was the strongest predictor of survival, with both localized and regional disease associated with substantially lower mortality compared with distant-stage disease. Conclusions: Racial disparities in pancreatic cancer are heavily driven by stage at diagnosis, particularly for Black and AI/AN populations. The finding that Black patients’ survival did not differ significantly from the reference after adjustment for stage and SES suggests that the observed survival gap is primarily due to later diagnosis rather than biological differences. These results highlight the critical need for targeted early detection strategies in minority communities to achieve health equity.