Disparities in Care: Impact of Socioeconomic Factors on Pancreatic Surgery: Exploring the National Cancer Database

Am Surg. 2019 Apr 1;85(4):327-334.


Studies have shown high-volume institutions have decreased mortality and increased survival for pancreatectomy. However, not all patients can travel to high-volume centers. Socioeconomic factors may influence treatment decisions. The goal of this study is to examine socioeconomic factors that determine where a patient is treated and how that location affects outcome. This is a retrospective study of the National Cancer Database of patients diagnosed with pancreatic cancer from 2004 to 2014. The primary outcome was to examine socioeconomic factors that predicted where a patient underwent their pancreatectomy. Patients treated at academic programs (APs) had to travel a mean distance of 80.9 miles, whereas patients treated at community programs (CPs) had to travel 31.7 miles (P < 0.0001). Spanish and Hispanic patients were less likely to travel to an AP (69% had surgery at an AP versus 76% of non-Hispanic patients, P < 0.001). Patients with higher comorbidities were also more likely to have care at CPs. Patients who had pancreatic cancer surgery at CPs were more likely to be Hispanic or with higher medical comorbidities. Those who had surgery at AP traveled further distances but had better perioperative outcomes and had an improvement in overall survival.

MeSH terms

  • Academic Medical Centers
  • Adenocarcinoma / economics
  • Adenocarcinoma / ethnology
  • Adenocarcinoma / mortality
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Databases, Factual
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / economics
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Hospitals, High-Volume
  • Humans
  • Male
  • Middle Aged
  • Pancreatectomy* / economics
  • Pancreatic Neoplasms / economics
  • Pancreatic Neoplasms / ethnology
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Retrospective Studies
  • Socioeconomic Factors*
  • Survival Analysis
  • Travel
  • Treatment Outcome
  • United States / epidemiology