S45 Socioeconomic Disparities in Survival Outcomes of Pancreatic Adenocarcinoma: Analysis of the National Cancer Database

Introduction: Pancreatic adenocarcinoma (PDAC) is an aggressive malignancy with a poor prognosis. Socioeconomic status (SES) is a critical but under-explored determinant of health disparities. This study investigated the interplay between SES and clinical outcomes across different AJCC stages of PDAC. Methods: Our study population was identified by querying the National Cancer Database for patients diagnosed with PDAC during 2004 to 2019. The quartile rankings of individual income and education levels were combined as a composite measure of SES, which identified 4 groups: low (2-3), mid-low (4-5), mid-high (6-7), and high (8) SES. Cox proportional hazards models were employed to compare overall survival (OS) between SES groups across each clinical stage of PDAC, adjusting for relevant demographic and clinical variables. Results: Of 45,409 PDAC patients, the distribution across SES groups was 18.17% for low SES (7,515 patients), 28.55% for mid-low SES (11,806 patients), 32.44% for mid-high SES (13,413 patients), and 20.84% for high SES (8,617 patients). Cox multivariate analysis revealed significantly decreased OS among patients in the low SES group (HR 1.14, 95% CI: 1.06-1.21), mid-low SES (HR 1.11, 95% CI: 1.05-1.18), and mid-high SES (HR 1.10, 95% CI: 1.04-1.16) when compared to the high SES reference group. Kaplan-Meier survival analysis confirmed that differences in OS across SES group remained statistically different within AJCC stages I, III, and IV. Insurance status also influenced survival, with Medicaid patients showing a higher risk compared to those with private insurance (HR = 1.26; 95% CI: 1.15-1.38). Female sex (HR = 0.94; 95% CI: 0.91-0.98), Hispanic ethnicity (HR = 0.84; 95% CI: 0.78-0.92) and clinical stage (HR = 1.74; 95% CI: 1.62-1.87), administration of chemotherapy (HR = 0.52; 95% CI: 0.50-0.55), and surgical resection (HR = 0.37; 95% CI: 0.35-0.40) were also associated with better survival outcomes. Conclusion: This analysis underscores significant survival disparities among patients with PDAC across different SES groups, with lower SES being consistently associated with poorer outcomes. The association between SES and insurance status as independent indicators of survival underscores the importance of considering socioeconomic factors in the clinical management of PDAC and highlights the necessity for healthcare policy reforms.