Understanding Disparities in Receipt of Complex Gastrointestinal Cancer Surgery at a Small Geographic Scale

Details

• Alternative Title:
  Ann Surg
• Personal Author:
  Dong, Weichuan ; Kucmanic, Matthew ; Winter, Jordan ; Pronovost, Peter ; Rose, Johnie ; Kim, Uriel ; Koroukian, Siran M. ; Hoehn, Richard
• Description:
  Objective:
  
  To define neighborhood-level disparities in the receipt of complex cancer surgery.
  
  Background.
  
  Little is known about the geographic variation of receipt of surgery among patients with complex gastrointestinal (GI) cancers, especially at a small geographic scale.
  
  Methods.
  
  This study included individuals diagnosed with five invasive, non-metastatic, complex GI cancers (esophagus, stomach, pancreas, bile ducts, liver) from the Ohio Cancer Incidence Surveillance System during 2009 to 2018. To preserve patient privacy, we combined US census tracts into the smallest geographic areas that included a minimum number of surgery cases (n=11) using the Max-p-regions method and called these new areas “MaxTracts”. Age-adjusted surgery rates were calculated for MaxTracts, and the Hot Spot analysis identified clusters of high and low surgery rates. US Census and CDC PLACES were used to compare neighborhood characteristics between the high- and low-surgery clusters.
  
  Results.
  
  This study included 33,091 individuals with complex GI cancers located in 1,006 MaxTracts throughout Ohio. The proportion in each MaxTract receiving surgery ranged from 20.7% to 92.3% with a median (IQR) of 48.9% (42.4–56.3). Low-surgery clusters were mostly in urban cores and the Appalachian region, whereas high-surgery clusters were mostly in suburbs. Low-surgery clusters differed from high-surgery clusters in several ways, including higher rates of poverty (23% vs 12%), fewer married households (40% vs 50%), and more tobacco use (25% vs 19%; all p<0.01).
  
  Conclusions.
  
  This improved understanding of neighborhood-level variation in receipt of potentially curative surgery will guide future outreach and community-based interventions to reduce treatment disparities. Similar methods can be used to target other treatment phases and other cancers.
  
  
• Subjects:
  Censuses Gastrointestinal Neoplasms Humans Ohio Poverty Residence Characteristics
• Keywords:
  Cancer Disparities Census Tracts Max-p Regionalization Surgery
• Source:
  Ann Surg. 278(5):e1103-e1109
• Pubmed ID:
  36804445
• Pubmed Central ID:
  PMC10440364
• Document Type:
  Journal Article
• Funding:
  R01 HL153175/HL/NHLBI NIH HHSUnited States/ ; R01 AG074946/AG/NIA NIH HHSUnited States/ ; U48 DP006404/DP/NCCDPHP CDC HHSUnited States/ ; P30 CA043703/CA/NCI NIH HHSUnited States/ ; UH2 DE025487/DE/NIDCR NIH HHSUnited States/ ; T32 GM007250/GM/NIGMS NIH HHSUnited States/ ; UH3 DE025487/DE/NIDCR NIH HHSUnited States/ ; TL1 TR002549/TR/NCATS NIH HHSUnited States/
• Volume:
  278
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a7cc776f6f9f330bcba03611e353f01d6c4ee314dc82b47ed7abf57f562330e7ab96b665c98d772703dd3e880f05ae4a3129cb38ceeb634b62b1a02eaf512324
• Download URL:
  https://stacks.cdc.gov/view/cdc/134518/cdc_134518_DS1.pdf
• File Type:
  [PDF - 1.60 MB ]