Exploration of rural disparities in pancreatic cancer staging and mortality to incidence ratio in Illinois.

Abstract

260 Background: Despite recent impetus towards regionalization of pancreatectomy to high-volume centers, rural disparities have not been explored for pancreas cancer outcomes. Analysis of the National Cancer Database showed less than one third of patients with resectable disease actually undergo surgery, suggesting opportunities for improvement in global systems related to pancreas cancer care, including appropriate referral for surgical resection. We intended to explore the impact of rurality and gastroenterologist (GI) density on staging and mortality for pancreas cancer. Methods: Age-adjusted pancreas cancer incidence and staging proportion were calculated for each county using 1991-2010 data from the Illinois State Cancer Registry. Age-adjusted mortality rates were calculated using SEER*STAT. Choropleth maps were created to illustrate Mortality-Incidence Ratios (MIRs) by Illinois county using ArcGIS. Mean GI density for each county was calculated from the US Area Health Resource File. USDA Economic Research Service rural-urban continuum codes (RUCC) and US census percent rurality data were used to designate county rurality and adjacency to metro counties. Chi-square, ANOVA, and Spearman’s rho calculations were performed. Results: A greater proportion of counties with high MIR were in Southern, more rural, Illinois. No GIs were located in 65 out of 102 Illinois counties (64%) during the time interval analyzed, with a mean density of 1.0 per 100,000. Counties without GIs were significantly more rural, poorer, and less educated than counties with GIs. Unstaged pancreas cancers were inversely correlated with GI density (Spearman’s rho=-0.20; p=0.04). MIR was positively correlated with percent rurality (Spearman’s rho=0.23; p=0.02). MIR was also predicted by RUCC category, and was significantly greater in rural regions not adjacent to metro counties (p=0.02). Conclusions: Higher rates of unstaged pancreas cancer and higher MIR were noted in rural regions, which may be influenced by the availability of gastroenterologists or other specialty services. Further exploration of the impact of distance from high-volume cancer centers on rural cancer outcomes is warranted.