Cancer epidemiology · 2026
Socioeconomic deprivation, rurality, and travel distance negatively impact survival in early-stage pancreatic ductal adenocarcinoma but are not associated with stage at diagnosis.
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Chong Bradford, Carlson Erin E, Bamlet William R, Sauver Jennifer St, Cheville Andrea L, Oberg Ann L, Majumder Shounak
Аннотация
BACKGROUND AND AIMS: The interactions between social determinants of health (SDOH) and survival across stages in pancreatic ductal adenocarcinoma (PDAC) are poorly understood. Our aims were to determine the associations of socioeconomic deprivation indices, rurality indices, and travel distance with PDAC stage at diagnosis and overall survival.
METHODS: Using the Rochester Epidemiology Project that encompasses the 27-county region of southeastern Minnesota and west-central Wisconsin, we retrospectively identified patients diagnosed with PDAC (1/1/10-12/31/20). Socioeconomic deprivation was defined using neighborhood-level Area Deprivation Index (ADI) quartiles and individual-level HOUSES index quartiles. Rurality was defined by Rural-Urban Commuting Area codes. Travel distance (miles) was calculated between residential address and Mayo Clinic. Primary measures were diagnosis stage and overall survival, analyzed via multi-level statistical models when appropriate.
RESULTS: We identified 1095 patients with PDAC (median age 72 years (63-80). For stage I PDAC, patients experienced worse survival across four SDOH summaries, from least to most deprived ADI quartile (adjusted HR (aHR) 5.59, 95% CI 2.15-14.50; p = 0.0019; least to most deprived HOUSES quartile (aHR 1.99, 95% CI 1.29-3.06; p = 0.022); increased distance (aHR 3.09, 95% CI 1.75-5.44; p = 0.0005); urban to large rural areas (aHR 2.39, 95% CI 1.28-4.46; p = .0008). None of the examined SDOH were associated with late-stage diagnosis or survival in stages II-IV.
CONCLUSIONS: Socioeconomic deprivation, rurality, and travel distance were associated with worse survival in early-stage PDAC. These determinants were not associated with delayed diagnosis. Targeted interventions for reducing healthcare disparities in early-stage PDAC may be needed to maximize the benefits of intercepting cancer early.
METHODS: Using the Rochester Epidemiology Project that encompasses the 27-county region of southeastern Minnesota and west-central Wisconsin, we retrospectively identified patients diagnosed with PDAC (1/1/10-12/31/20). Socioeconomic deprivation was defined using neighborhood-level Area Deprivation Index (ADI) quartiles and individual-level HOUSES index quartiles. Rurality was defined by Rural-Urban Commuting Area codes. Travel distance (miles) was calculated between residential address and Mayo Clinic. Primary measures were diagnosis stage and overall survival, analyzed via multi-level statistical models when appropriate.
RESULTS: We identified 1095 patients with PDAC (median age 72 years (63-80). For stage I PDAC, patients experienced worse survival across four SDOH summaries, from least to most deprived ADI quartile (adjusted HR (aHR) 5.59, 95% CI 2.15-14.50; p = 0.0019; least to most deprived HOUSES quartile (aHR 1.99, 95% CI 1.29-3.06; p = 0.022); increased distance (aHR 3.09, 95% CI 1.75-5.44; p = 0.0005); urban to large rural areas (aHR 2.39, 95% CI 1.28-4.46; p = .0008). None of the examined SDOH were associated with late-stage diagnosis or survival in stages II-IV.
CONCLUSIONS: Socioeconomic deprivation, rurality, and travel distance were associated with worse survival in early-stage PDAC. These determinants were not associated with delayed diagnosis. Targeted interventions for reducing healthcare disparities in early-stage PDAC may be needed to maximize the benefits of intercepting cancer early.