Early-stage Pancreatic Ductal Adenocarcinoma Diagnosis Is Inversely Associated With Travel Distance and Travel Time.

Abstract

Objective: Leveraging geospatial data and SDOH (social determinants of health) indices may enhance understanding of the interactions between geographic and social factors that facilitate early cancer diagnosis. We sought to characterize associations between travel distance, time, and early-stage pancreatic ductal adenocarcinoma (PDAC) diagnosis.

Methods: This was a retrospective study of PDAC patients at an urban academic medical center between January 1, 2012, and February 31, 2022. We geocoded patients to census tracts to calculate car travel distance and time. For residents within city limits, we calculated public transit time. The primary outcome was stage I diagnosis. Logistic regression was used for travel measures, and multivariable analyses adjusted for age, diagnosis year, and insurance. Sensitivity analyses were done using the Area Deprivation Index and the SDOH Atlas.

Results: We identified 694 PDAC patients, with 146 (23.2%) having a stage I diagnosis. Residing >25 miles and car travel time >45 minutes were associated with early diagnosis (OR: 2.35, 95% CI [1.41, 3.98], OR 2.49, 95% CI [1.53, 4.14] respectively). On sensitivity analyses, these associations persisted in low to moderate deprivation neighborhoods. Among city residents, there was no association between travel measures and early diagnosis.

Conclusions: Patients in less socioeconomically deprived neighborhoods are diagnosed at an earlier stage despite traveling longer distances and times.