Racial and Ethnic Disparities in Receipt of Guideline-Concordant Pancreatic Cancer Care Among Older Adults in the United States.

Abstract

Purpose: Patients racialized as Black experience a higher mortality from pancreatic cancer (PC). Worse survival outcomes may relate to differences in delivered treatment. This study examined differences in receipt of guideline-concordant care (GCC) among older adults with PC according to race and ethnicity.

Methods: Patients 65 years and older with incident PC racialized as non-Hispanic White (NH-White) or racialized as NH-Black or of Hispanic ethnicity were identified in the SEER-Medicare database from 2004 to 2019. The primary outcome was receipt of stage-specific GCC. Multivariable logistic regression identified factors associated with GCC. Oaxaca-Blinder decomposition examined the contribution of measured and unmeasured variables to racial disparities in receipt of GCC.

Results: Of 12,772 patients included, 85.5% of patients racialized as NH-White (n = 10,915), 7.8% of patients racialized as NH-Black (n = 992), and 6.8% of patients were of Hispanic ethnicity (n = 865). In total, 56.3% of patients received GCC. On adjusted analysis, patients racialized as NH-Black were less likely to receive GCC for stage I/II disease compared with patients racialized as NH-White (odds ratio [OR], 0.66 [95% CI, 0.53 to 0.83]), but not for stage III (OR, 0.65 [95% CI, 0.41 to 1.01]) or stage IV (OR, 0.87 [95% CI, 0.66 to 1.14]). GCC did not differ between Hispanic patients and NH-White patients. On decomposition analysis, differences in GCC among NH-Black and NH-White patients remained largely unexplained, but dual eligibility, census tract-level poverty, and comorbidities were the measured factors that contributed most to the disparity in GCC.

Conclusion: Approximately half of an insured population with PC receives GCC, highlighting a need to improve multidisciplinary access and treatment. Black-White racial disparities in receipt of GCC remain prevalent, particularly for early-stage disease. The unmeasured factors driving treatment disparities warrant prospective studies.