Racial and socioeconomic disparities in surgical management and outcomes in pancreatic adenocarcinoma: a single-center experience in the last 13 years.

Abstract

Background: Pancreatic adenocarcinoma (PaC) is an aggressive cancer with a poor prognosis. While disparities in surgical management and outcomes have been reported, most studies use outdated or population-level data, limiting their relevance in modern clinical settings. This study examined the impact of race and socioeconomic status on pancreatic resection rates and survival outcomes in PaC patients.

Methods: A retrospective analysis of 525 patients diagnosed with PaC at a single institution (2010-2024) was conducted. Demographics, tumor characteristics, resection rates, and survival outcomes were assessed. Socioeconomic status was inferred from zip codes. Logistic regression and Cox proportional hazards models were used to evaluate treatment access and survival.

Results: African American patients had lower resection rates than White patients (20.0% vs. 36.1%; p < 0.001), even after adjusting for resectable stages. Resection likelihood was reduced by being African American (OR 0.27; p < 0.001), older age (OR 0.97/year; p = 0.007), advanced stage (OR 0.09; p < 0.001), and lower education (OR 0.86; p = 0.003). Mean survival was shorter for African Americans than White patients (405.7 vs. 426.8 days; p < 0.001) but nonsignificant after adjustments (HR 1.19; p = 0.34).

Conclusions: Racial and socioeconomic disparities persist in PaC surgical management, impacting outcomes. Addressing these inequities through improved access to care is essential for achieving more equitable treatment.