Socioeconomic Factors Associated With a Late-Stage Pancreatic Cancer Diagnosis: An Analysis of the National Cancer Database.
Socioeconomic Factors Associated With a Late-Stage Pancreatic Cancer Diagnosis: An Analysis of the National Cancer Database.
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DOI：
10.7759/cureus.35857
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发表时间：
2023-03
期刊：
影响因子：
--
通讯作者：
Silberstein PT
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文献类型：
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作者：
Gallegos JM;Taylor A;Vardell V;Silberstein PT
背景
胰腺腺癌是一种侵袭性强、致命的癌症。它是美国癌症死亡的第四大原因，并且在晚期之前通常无症状。因此，在疾病病程早期识别患者至关重要。社会经济因素有助于确定哪些人在疾病晚期就诊的风险更高。利用美国国家癌症数据库（NCDB），我们旨在确定社会经济因素与胰腺癌诊断时的分期之间的关联。
方法
在这项研究中，对2004年至2018年期间在NCDB中被诊断为0 - I期和IV期胰腺癌的256,822名患者，根据年龄、种族、性别、族裔、保险类型、收入、地理位置、教育程度和查尔森 - 迪约评分进行了比较。使用卡方检验和多变量逻辑回归比较了早、晚期疾病患者的人口统计学因素。
结果
我们发现种族、性别、保险状况、教育程度、收入和地理位置与诊断时的疾病分期之间存在显著关联。男性比女性更有可能被诊断为晚期癌症（52.8%对47.9%，p < 0.001）。与男性相比，女性更有可能被诊断为早期（优势比（OR）= 0.857，95%置信区间（CI）= 0.839 - 0.875，p < 0.001）。与白人患者相比，黑人患者就诊时处于更晚期（OR = 1.106，95% CI = 1.069 - 1.144，p < 0.001）。私人保险和医疗补助保险的晚期诊断率高于早期，而所有其他类型的保险晚期诊断率低于无保险患者（p < 0.001）。来自家庭收入中位数低于38,000美元的邮政编码地区以及高中毕业率较低的邮政编码地区的患者晚期诊断率更高（p < 0.025）。
结论
与早期相比，增加胰腺癌晚期就诊可能性的因素包括多个少数族裔和传统上服务不足的人群。黑人种族、保险不足或居住在低收入或低教育水平的邮政编码地区与晚期就诊显著相关，这与更差的生存结果密切相关。
Background Pancreatic adenocarcinoma is an aggressive, lethal cancer. It is the fourth leading cause of cancer death in the United States and is often asymptomatic until later stages. Thus, it is critical to identify patients earlier in their disease course. Socioeconomic factors can assist in determining who is at higher risk of presenting at later stages of the disease. Using the National Cancer Database (NCDB), we aim to identify the associations between socioeconomic factors and the stage of pancreatic cancer at diagnosis. Methodology In this study, 256,822 patients from the NCDB who were diagnosed with pancreatic cancer from 2004 to 2018 at stage 0-I and stage IV were compared based on age, race, sex, ethnicity, insurance type, income, geographic location, education, and Charlson-Deyo score. Demographic factors of patients who presented with early and late-stage disease were compared using the chi-squared test and multivariate logistic regression. Results We identified significant associations between race, sex, insurance status, education, income, and geographic location with the stage of disease at diagnosis. Males were more likely to be diagnosed with late-stage cancer than early-stage (52.8% vs. 47.9%, p < 0.001). Females were more likely to have an earlier-stage diagnosis when compared to males (odds ratio (OR) = 0.857, 95% confidence interval (CI) = 0.839-0.875, p < 0.001). Black patients presented at a later stage when compared to White patients (OR = 1.106, 95% CI = 1.069-1.144, p < 0.001). Private and Medicaid insurance had higher rates of late-stage diagnosis than early stages, and all other types of insurance had lower rates of late-stage diagnosis than patients without insurance (p < 0.001). Patients from a zip code with less than $38,000 median household income and zip codes with lower levels of high school graduation had higher rates of late-stage diagnosis (p < 0.025). Conclusions Factors associated with the increased likelihood of pancreatic cancer presentation at the advanced stage compared to the early stage include multiple minority and traditionally underserved populations. Black race, underinsurance, or residing in low-income or low-education zip codes was significantly associated with presenting at a late stage, which is strongly associated with worse survival outcomes.