88 Racial and Gender Disparities Among Obese Patients With Pancreatic Cancer: A Trend Analysis From 2004–2018 in the United States

Abstract

INTRODUCTION: Obesity increases the risk of pancreatic cancer by up to 50%. Epidemiologic studies indicate that disparities exist in obesity trends across different demographics in the United States. This is suspected to be from modifiable risk factors, comorbidities, and differences in the gut microbiome, along with social determinants of health such as a lack of access to high-volume treatment centers. Our aim is to determine if variation exists in the demographic of obese pancreatic cancer patients over the last 15 years. METHODS: We performed a retrospective analysis in the IBM Explorys database (1999–2018), a pooled, de-identified clinical database of unique patient records from 26 health care networks and 300 hospitals across the United States. At the time of analysis there were 63,744,040 patients, of which 9,620 were adults (>18 years old) with both pancreatic cancer and obesity (BMI >30). Patient populations were identified using SNOMED and ICD codes. Cochrane-Armitage testing was performed to analyze trends in obesity among pancreatic cancer patients between 2004–2018. Subgroup analysis for gender, age, race, and mortality rate were assessed. RESULTS: The percentage of obese patients with pancreatic cancer increased over the 15-year period (2.5% to 8.5%); P = <0.0001). Rates of obesity among pancreatic cancer patients increased among females (P = 0.0004), individuals under age 65 years (P = 0.0002), and all-races, but especially for African Americans (P = 0.0007) and those in minority groups. CONCLUSION: Pancreatic cancer is becoming more common among patients who are obese, younger, female, and not Caucasian. African Americans have been shown to have a higher incidence and mortality from pancreatic cancer. This disparity has been attributed to lifestyle habits, co-morbidities including obesity, and a lack of access to high-volume treatment centers. However, differences in gene expression also increase the risk. Although these could be therapeutic targets, low minority enrollment in research studies is a barrier to progress. This is the first study to assess demographic trends in obese pancreatic cancer patients over the last 15 years. Awareness of disparities in pancreatic cancer and applying more precise population approaches to those at increased risk are essential to improving future outcomes. An integrated approach should include increased health care access and recruitment in research studies for minority groups.