Association of Social Determinants of Health with Delays in Diagnosis and Treatment of Resected Pancreatic Ductal Adenocarcinoma (PDAC)

BACKGROUND: Delayed diagnosis and treatment worsen survival in pancreatic ductal adenocarcinoma (PDAC). Despite many potential causes, the influence of social determinants of health (SDoH) is understudied. We evaluated whether SDoH impact delays in diagnosis and treatment among patients who underwent resection for PDAC. PATIENTS AND METHODS: Adults resected at a high-volume center were included (January 2016-November 2024). SDoH included insurance status, census-level income and education, rural-urban residence, and Area Deprivation Index. Primary endpoints were time from first imaging to histological diagnosis and time from first imaging to treatment initiation. Delay thresholds were derived using receiver operating characteristic analysis against overall survival. Uni- and multivariable logistic regression identified factors associated with delays, adjusting for demographic and clinical covariates, stratified by outpatient (OUP) versus emergency room (ER) presentation. RESULTS: Among 317 patients, the median age was 67 years, and 42.3% were female; 50.1% presented through ER. The median imaging-to-diagnosis interval was 11 days (interquartile [IQR] 3-27 days), and the median imaging-to-treatment interval was 40 days (IQR 27-59 days). In the OUP cohort, Medicare insurance was associated with delayed diagnosis compared with private insurance (OR 3.34 [95% CI 1.09-11.70]), whereas higher income was associated with up to 84% lower odds of delayed treatment. In the ER cohort, higher education was associated with reduced odds of delayed diagnosis (OR 0.27 [95% CI 0.07-0.88]) and delayed treatment (OR 0.33 [95% CI 0.11-0.91]). Post-endoscopic retrograde cholangiopancreatography (ERCP) hospitalization predicted delays in the ER setting, whereas alarm symptoms reduced delays in both settings. CONCLUSIONS: SDoH are associated with diagnostic and treatment delays in resected PDAC. Targeted interventions may accelerate care and improve equity in outcomes.