Socioeconomic disparities in pancreatic cancer treatment: The role of pre-diagnosis healthcare utilization.

Abstract

e16384 Background: Pancreatic cancer treatment patterns vary widely, influenced by a range of factors beyond clinical characteristics. Access to timely and appropriate care is critical for ensuring equitable treatment outcomes. Pre-diagnosis utilization of outpatient and emergency department (ED) services may provide insights into access to care and barriers to treatment. This study examines the relationship between SES, access to care as proxied by pre-diagnosis outpatient and ED utilization, and pancreatic cancer treatment patterns using SEER-Medicare data. Methods: We analyzed SEER-Medicare data for beneficiaries aged ≥66 diagnosed with pancreatic cancer from 2008 to 2017. Treatment was categorized as no treatment, single-modality, & multimodal treatment. Independent variables included neighborhood-level SES indicators (income, education), individual factors (age, sex, race/ethnicity, marital status), and healthcare access as proxied by pre-diagnosis outpatient and ED utilization. Pre-diagnosis utilization was grouped into no (0 visits), low (infrequent visits), or high (frequent visits) based on the number of outpatient or ED encounters within 1 year before diagnosis. Multivariable logistic regression estimated the likelihood of receiving treatment, controlling for potential confounders including stage of disease, age, comorbidities, and year of diagnosis. Results: Among 20,362 patients, the stage distribution was as follows: 0.72% had stage 0, 8.81% stage 1, 28.99% stage 2, 9.81% stage 3, and 51.67% stage 4 disease. Socioeconomic disparities were evident, with individuals from low-income and low-education areas having higher odds of receiving no treatment or single-modality treatment compared to multimodal treatment. In stages 0–2, low income was associated with increased odds of no treatment (OR = 1.23, p < 0.01), while in stages 3–4, a high percentage of individuals without a high school education increased the odds of no treatment (OR = 1.38, p < 0.01). Pre-diagnosis healthcare utilization played a significant role; patients with high outpatient care utilization had lower odds of no treatment (OR = 0.33, p < 0.01), while high ED utilization was linked to greater odds of no treatment (OR = 3.72, p < 0.01). Non-Hispanic Black patients had higher odds of no treatment (OR = 1.57, p < 0.01), while married patients had lower odds (OR = 0.55, p < 0.01). Conclusions: Pre-diagnosis healthcare utilization and socioeconomic status provide valuable context for understanding disparities in access to pancreatic cancer treatment. Access to care, as proxied by pre-DX healthcare utilization, is linked to higher multimodal treatment rates, while higher ED utilization, a marker of low access, is associated with no treatment. Addressing socioeconomic barriers and enhancing early healthcare engagement are crucial to improving treatment access, particularly among vulnerable populations.