Racial, socioeconomic, and geographic disparities in survival among patients with ampullary carcinoma: A population-based SEER analysis (2000–2022).

Abstract

e16483 Background: Ampullary carcinomas (AC) are rare malignancies comprising ~0.2% of GI cancers with limited population-level data. Although social determinants of health (SDOH) influence outcomes in many GI cancers, their impact on AC remains unclear. We evaluated the association between SDOH and survival in a large national cohort of patients with AC. Methods: We conducted a retrospective cohort study using the SEER-17 database to identify patients with AC (ICD-O-3 site C24.1; histology codes 8140–8147, 8480, 8490, 8500) diagnosed between 2000 and 2022. Variables included sex, race, median household income, and geography. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan–Meier methods and Cox regression, with patients diagnosed through 2017 for ≥5-year follow-up. Analyses were performed in Python (v3.12) using lifelines and pandas, reporting adjusted hazard ratios (HRs) with 95% confidence intervals (CIs); p < 0.05 was considered statistically significant. Results: A total of 9,026 patients were included; 56.3% were male, and 82.5% lived in metropolitan areas. Racial distribution was 60.8% White, 18.4% Hispanic, 12.6% Asian, and 7.4% Black. Median OS was 21 months (95% CI, 20–22) and median CSS was 32 months (95% CI, 30–34). Race was significantly associated with OS and CSS on unadjusted analysis (p < 0.001), with Black patients having shorter survival than White patients (median OS: 14 vs 19 months; median CSS: 21 vs 32 months). On multivariable analysis, Black race remained independently associated with worse OS (HR 1.13, 95% CI 1.03–1.24, p = 0.010) and CSS (HR 1.16, 95% CI 1.04–1.29, p = 0.006), while sex was not associated with survival. Higher household income ( > $90,000; Q3) was associated with improved survival on unadjusted analysis, with significantly better OS (HR 0.85, 95% CI 0.79–0.92, p < 0.001) and CSS (HR 0.87, 95% CI 0.80–0.95, p = 0.002) compared with lower income( < 60,000; Q1). These associations remained significant on multivariable analysis, with Q3 demonstrating improved OS (HR 0.85, p < 0.001) and CSS (HR 0.87, p = 0.002). Patients in non-metropolitan areas had worse OS and CSS on unadjusted analysis (median OS: 18 vs 22 months; median CSS: 27 vs 34 months; both p = 0.001). However, geographic status was not independently associated with survival on multivariable analysis (OS HR 0.99; CSS HR 0.95). Conclusions: In this population-based study of ampullary carcinoma, Black race and lower household income were independently associated with worse overall and cancer-specific survival, highlighting the need for interventions to improve healthcare access and reduce structural inequities. Future research should investigate the social, biological, and healthcare factors driving these disparities to inform targeted strategies for high-risk populations.