Neighborhood-level socioeconomic disadvantage and pancreatic cancer among veterans

Individual-level social determinants of health are associated with pancreatic ductal adenocarcinoma; however, it is currently unknown whether neighborhood-level socioeconomic disadvantage is related to the risk of pancreatic ductal adenocarcinoma diagnosis. Area deprivation index is a validated tool to measure neighborhood-level disadvantage. We conducted a retrospective cohort study of 5 069 429 patients in the Veterans Health Administration between October 1, 2001, and December 31, 2021. Area deprivation index percentiles were grouped using national area deprivation index decile cutoffs. In multivariable analysis, the lowest area deprivation index group, representing the highest neighborhood-level socioeconomic status, was associated with increased hazards for pancreatic ductal adenocarcinoma (adjusted hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.06 to 1.21) compared with those with median area deprivation index percentiles. Differences in pancreatic ductal adenocarcinoma hazards were not seen in the other area deprivation index percentiles. These results suggest that within the Veterans Health Administration, a relatively equal access health-care system, there is limited contribution of neighborhood-level socioeconomic deprivation to pancreatic ductal adenocarcinoma, except for patients with the highest neighborhood-level socioeconomic status (lowest area deprivation index).