Income and its impact on adenomatous neoplasms outcomes: An analysis of the National Cancer Database.

Abstract

723 Background: Adenomatous neoplasmsof the small intestine are rare benign tumors but are occurring with increasing incidence. They exhibit a slight male predominance, with a median age of diagnosis in the 6th decade of life. The duodenum is the most frequent location of onset. Proposed environmental risk factors include high animal fat and protein diets, intestinal flora composition, and hereditary factors. Additionally, intestinal diseases, such as Crohn’s disease or Lynch syndrome, predispose individuals to develop small intestine adenomatous neoplasms. Despite this knowledge, no National Cancer Database (NCDB) research exists analyzing the association between survivability and income. Therefore, the objective of this study is to investigate overall survival rates among individuals with adenomatous neoplasms based on income levels. Methods: The NCDB was used to identify patients diagnosed with small intestine adenomatous neoplasms from 2004 to 2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square tests were performed, and data were analyzed using SPSS version 27. Statistical significance was set at α = 0.05. Results: Of 19,582 patients included in the sample, 6,326 (30.8%) were from the highest income bracket, defined as annual income greater than $46,000, while 3,629 (24.4%) were from low-income brackets, defined as earnings less than $30,000. High-income patients experienced longer mean overall survival (58.5 months) compared to middle (49.7 months) and low (46.7 months) income patients (p<0.001). After controlling for age at diagnosis, sex, race, facility type, surgery status, adjunctive therapies, and insurance type, both the low- and middle-income brackets were associated with an independent increase in hazard (HR = 1.284 and 1.177 respectively; p<0.001). High income was associated with fewer comorbidities (72.2%) compared to low (65.9%) and middle-income (68.4%) patients (p<0.001). High-income patients were more likely to be treated at academic facilities (41.9%) compared to low (39.2%) or middle-income (35.4%) individuals (p<0.001), which have longer survivability (58.9 months vs. 47.8 months in non-academic facilities; p<0.001). Additionally, high income was also associated with increased rates of private insurance ownership (38.0%) while low-income individuals were more likely to have Medicaid (9.5%) or be uninsured (5.1%; p<0.001). No significant differences were found in tumor grade or differentiation, staging, metastasis, or surgical margins. Conclusions: This study indicates an association between high-income patients and increased survivability, while also observing an association with low-income and decreased survivability. Further research is required to assess specific environmental risk factors of adenomatous neoplasms and their relation to income level.