Evaluating the Association of Area Deprivation Index (ADI) on Postoperative Outcomes in Pancreatic Adenocarcinoma.

IF 2 3区 医学 Q3 ONCOLOGY
Abdullah Khalid, Shamsher A Pasha, Lyudmyla Demyan, Oliver Standring, Daniel A King, Elliot Newman, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis
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引用次数: 0

Abstract

Introduction: Pancreatic adenocarcinoma (PDAC) is a challenging disease, with outcomes influenced by several factors including socioeconomic status. The area deprivation index (ADI) has been used to understand how neighborhood disadvantages affect healthcare outcomes. Prior research has indicated that a higher ADI, reflective of a greater neighborhood disadvantage, is associated with an increased risk of major complications and unplanned readmission following PDAC resection. This study aimed to extend this investigation to the Northwell Health System in New York and explore the association between neighborhood ADI and surgical outcomes in patients with PDAC.

Methods: A retrospective analysis of the Northwell Health multicenter pancreatic cancer database from 2014 to 2023 included patients who underwent PDAC resection. The ADI scores were divided into low (1-3), moderate (4-6), and high (7-10), as previously described. Multinomial regression models and Kaplan-Meier log-rank tests were used to compare differences in surgical outcomes between the patients in each ADI group.

Results: Out of 314 PDAC patients who underwent resection and had available ADI data, 116 (36.9%) were in the low, 163 (51.9%) in the moderate, and 35 (11.2%) in the high ADI category. The median ADI score was 4 (IQR: 3-5). Adjusted multinomial regression analysis revealed the following disparities: compared to the low ADI group, patients in the moderate ADI group demonstrated a significantly higher risk of diabetes (RR: 1.76, 95% CI 1.06-2.90, p = 0.028); high ADI was associated with a poorer response to neoadjuvant therapy (RR 3.13, 95% CI 1.11-8.82, p = 0.031), higher incidence of microscopic positive margins (RR 1.87, 95% CI 1.11-5.17, p = 0.028), increased severe complications (Clavien-Dindo class III-IV) (RR 1.36, 95% CI 1.04-1.80, p = 0.027), and a higher failure-to-rescue (FTR) rate (RR 1.44, 95% CI 1.12-1.85, p = 0.048). Although readmission and mortality rates at 30 and 90 days did not show significant differences (p > 0.05), the Kaplan-Meier log-rank test indicated a marked disparity in survival probabilities among ADI ranks (p = 0.0025).

Conclusion: This study underscores a pronounced survival disparity across ADI categories among PDAC patients, suggesting an association between socioeconomic status and postoperative survival. Consideration of patient ADI may guide tailored healthcare strategies, such as the distribution of navigation and resources, to bridge the gap in survival outcomes and ensure equitable care for all socioeconomic strata.

评估地区剥夺指数(ADI)与胰腺腺癌术后疗效的关系
简介胰腺腺癌(PDAC)是一种具有挑战性的疾病,其治疗效果受到包括社会经济地位在内的多种因素的影响。地区贫困指数(ADI)被用来了解邻里劣势如何影响医疗结果。先前的研究表明,ADI越高,反映出邻里关系越差,PDAC切除术后出现主要并发症和非计划再入院的风险就越高。本研究旨在将这一调查扩展到纽约诺斯韦尔医疗系统,并探讨邻里ADI与PDAC患者手术结果之间的关系:对2014年至2023年期间诺斯韦尔健康多中心胰腺癌数据库进行回顾性分析,纳入了接受PDAC切除术的患者。如前所述,ADI评分分为低分(1-3分)、中分(4-6分)和高分(7-10分)。采用多项式回归模型和 Kaplan-Meier 对数秩检验比较各 ADI 组患者手术结果的差异:在314例接受了切除术且有ADI数据的PDAC患者中,116例(36.9%)属于低ADI组,163例(51.9%)属于中ADI组,35例(11.2%)属于高ADI组。ADI 中位数为 4(IQR:3-5)。调整后的多项式回归分析显示了以下差异:与低 ADI 组相比,中度 ADI 组患者患糖尿病的风险明显更高(RR:1.76,95% CI 1.06-2.90,P = 0.028);高 ADI 与新辅助治疗反应较差有关(RR 3.13,95% CI 1.11-8.82,p = 0.031)、显微镜下边缘阳性发生率较高(RR 1.87,95% CI 1.11-5.17,p = 0.028)、严重并发症(Clavien-Dindo III-IV 级)增加(RR 1.36,95% CI 1.04-1.80,p = 0.027)以及抢救失败(FTR)率较高(RR 1.44,95% CI 1.12-1.85,p = 0.048)。虽然30天和90天的再入院率和死亡率没有显示出显著差异(P > 0.05),但卡普兰-米尔对数秩检验表明,ADI等级之间的生存概率存在明显差异(P = 0.0025):本研究强调了 PDAC 患者在 ADI 类别之间存在明显的生存差异,表明社会经济状况与术后生存之间存在关联。考虑患者的 ADI 可指导量身定制的医疗策略,如导航和资源分配,以缩小生存结果的差距,确保为所有社会经济阶层提供公平的医疗服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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