DOES RESIDENCE IN AN AREA OF HIGH DEPRIVATION IMPACT RECEIPT OF CANCER CARE: AN ANALYSIS OF PATIENTS WITH PANCREATIC CANCER
Rida Ahmad*, Krisha Amin, Martin J. Heslin, Annabelle L. Fonseca
Surgery, University of South Alabama, Mobile, AL
Introduction: Access to specialized oncologic care is critical for improved prognosis in pancreatic cancer. Studies have shown that patients living in high Area Deprivation Index (ADI) regions are more likely to have low median income, lack means of transportation and access to basic health care facilities. We aim to understand the impact of residing in areas of high ADI on access to care in patients with pancreatic cancer.
Methods: We performed a retrospective review of patients identified from an institutional database, from October 2017 to August 2022. Individual patient ADI ranks were assigned using a 9-digit zip code and divided into terciles, with high tercile indicating the most disadvantaged group. Chi-square test statistics are reported for factors impacted by ADI rank.
Results: 52.6% (n=105) of 223 patients resided in areas of medium to high deprivation. 50% of Black patients (n=24) lived in areas of high ADI compared with 10% of White patients (n=17). Residence in areas of higher ADI was significantly associated with decreased receipt of guideline concordant care (GCT) with 10% (n=14) of patients residing in high ADI areas receiving GCT, compared with 32.1% (n=45) of patients in medium ADI, and 57.9% (n=81) of patients in low ADI (χ2=18.69 p<0.001). Residence in areas of medium to high ADI were also associated with increased Emergency Department utilization (χ2=14.70 p=0.001), and with decreased prior cancer screening uptake (13.1% in high ADI compared with 29% in medium ADI and 57.9% in low ADI, χ2=8.08 p=0.018). There was no significant difference in access to primary care based on residence (χ2=4.21 p=0.122).
Conclusion: Patients with pancreatic cancer residing in areas of high ADI are less likely to receive evidence-based guideline-concordant care and are more likely to have higher ED utilization. Patients residing in high ADI areas are more likely to be Black and have lower cancer screening uptake, potentially indicating decreased access to healthcare. Further studies are needed to assess the impact of residence on delivery of GCT, as well as to assess specific barriers that may be addressed through targeted interventions.
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