S265 Demographic and Socioeconomic Disparities in Surveillance of Newly Diagnosed Pancreatic Cysts

Introduction: The widespread use of abdominal imaging has increased the incidental detection of pancreatic cystic neoplasms (PCNs). The International Association of Pancreatology (IAP) has established guidelines for their evaluation. This study assessed how demographic and socioeconomic factors influence appropriate surveillance of newly diagnosed PCNs. Methods: Using a validated algorithm, we identified all patients across our healthcare system with a newly discovered pancreatic cyst from January 2018 to April 2022. Exclusion criteria included known PCNs, nonneoplastic cysts, concomitant malignancy, cysts <1 cm, and cysts detected during surveillance imaging. We collected data on age, sex, race, employment, U.S. citizenship, primary language, and insurance. Neighborhood adversity was measured using the Area Deprivation Index (ADI), reported by state decile and national percentile. Adherence to IAP guidelines was determined, and Chi-square tests evaluated differences across groups. Multivariable regression assessed predictors of adherence. Results: A total of 256 patients were included; 42 cysts had worrisome features (WF). Table 1 shows the adherence with IAP guidelines across collected factors. Patients <65 years were less adherent than those ≥65 (P = 0.003), and individuals in the more deprived half of state ADI were less adherent than those in the less deprived half (P = 0.006). Table 2 shows a subgroup analysis of cysts with WF [Tables presented at ACG annual meeting]. In the WF subgroup, there were no significant differences in adherence by any characteristics. In multivariable regression, age ≥65 was associated with increased adherence (odds ratio 4.68, 95% CI: 1.3–18.8), while age <65 was linked to decreased adherence (odds ratio 0.21, 95% CI: 0.06–0.77). No other demographic or socioeconomic factor significantly predicted adherence in the full or WF only groups. Conclusion: Our results suggest that patients under 65 are less likely to receive guideline concordant surveillance, possibly due to lower healthcare engagement or awareness. Additionally, individuals in more disadvantaged states (higher ADI) are less likely to adhere, highlighting the influence of social determinants of health. Reassuringly, adherence in the WF subgroup did not vary by demographic or socioeconomic status, indicating that higher-risk patients are being appropriately followed. The lack of associations with other factors may be due to sample size limitations or population homogeneity.