Socioeconomic factors associated with a late-stage pancreatic cancer diagnosis: An analysis of the national cancer database.

Abstract

4135 Background: Pancreatic cancer is an aggressive, lethal cancer that is the 4th leading cause of cancer death in the United States. It is often asymptomatic until later stages, thus it is critical to assess the socioeconomic factors associated with diagnosis at early vs. late stages. Using the National Cancer Database, we aim to identify associations between socioeconomic factors of patients that present with early stage (0-I) pancreatic cancer in comparison to late-stage disease (stage IV) at diagnosis. Methods: In this study, 256,822 patients from the National Cancer Database who were diagnosed with NCDB Analytic Stage Group stage 0-I and stage IV pancreatic cancer were analyzed based on age, race, sex, ethnicity, insurance type, income, geographic location, education and Charlson-Deyo score. Demographic factors of patients that presented with early and late-stage disease were analyzed using chi square and multivariate analysis. All patients included in the study were diagnosed with pancreatic cancer between 2004 and 2018. Results: We identified significant ( P <0.05) associations between race, sex, insurance status, education, income, and geographic location with diagnosis of advanced-stage disease. A greater percentage of males were diagnosed with late-stage cancer than early-stage (52.8% vs 47.9%). Females were more likely to have an earlier-stage diagnosis and were 15% less likely to have late-stage diagnosis than males (p < 0.001 and 95% CI = 0.839-0.875). African Americans were 10% more likely to have a late-stage diagnosis than Caucasians (p < 0.001 and 95% CI = 1.069-1.144). For insurance status, private and Medicaid insurance had higher percentages of late-stage diagnosis than early-stages, and all types of insurance had lower rates of late-stage diagnosis than patients without insurance (p < 0.001). Patients from a zip-code associated with < $38,000 median household income and zip-codes with lower levels of high school diplomas had higher rates of late-stage diagnosis (p < 0.025). Conclusions: Factors associated with increased likelihood of pancreatic cancer presentation at advanced stage compared to early stage include race, sex, insurance status, education, median income, comorbidity score, and geographic location.