Impact of Socioeconomic Status on Early Gastric Cancer Outcomes and Treatment Disparity: a SEER analysis.

IF 2.2 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2026-09-28 DOI:10.1007/s12029-026-01604-w

Rinrada Worapongpaiboon, Sonmoon Mohapatra, Kasenee Tiankanon, Saowanee Ngamruengphong

{"title":"Impact of Socioeconomic Status on Early Gastric Cancer Outcomes and Treatment Disparity: a SEER analysis.","authors":"Rinrada Worapongpaiboon, Sonmoon Mohapatra, Kasenee Tiankanon, Saowanee Ngamruengphong","doi":"10.1007/s12029-026-01604-w","DOIUrl":null,"url":null,"abstract":"Purpose: The influence of socioeconomic determinants of health on early gastric adenocarcinoma (GAC) remains understudied. We evaluated the association between median household income (MHI), treatment patterns, and survival in T1aN0M0 GAC.Methods: Using the SEER-17 Research Plus database (2004-2021), we identified 3,792 patients with T1aN0M0 GAC. MHI was stratified into tertiles. Overall survival (OS), cancer-specific mortality (CSM), and non-cancer-specific mortality (NCSM) were assessed with Kaplan-Meier methods. Independent predictors of CSM were identified using multivariable Fine-Gray competing-risk regression.Results: Patients in the lowest MHI tertile were younger, more likely to be Black, unemployed, and to receive no definitive treatment (surgery or endoscopic therapy (ET)) despite similar tumor size (all P < 0.001) vs higher tertiles. Treatment patterns varied by income: highest MHI patients were more likely to undergo ET, while lowest MHI patients more often received chemotherapy/radiation and no definitive therapy. Compared with the highest MHI group, the lowest MHI group had worse outcomes, with lower 5-year OS (82.3% vs. 86.0%) and higher 5-year CSM (17.6% vs. 13.6%; both P < 0.001). NCSM did not differ across income tertiles. Compared with the lowest MHI tertile, the middle (sHR 0.68, 95% CI 0.55-0.83; P < 0.001) and highest MHI tertiles (sHR 0.72, 95% CI 0.56-0.93; P = 0.011) were associated with significantly lower CSM. Older age ( ≥ 65 years), tumor size ≥ 2 cm, poor tumor differentiation, no definitive treatment, and receipt of radiation therapy were independently associated with higher CSM, whereas Asian or Pacific Islander race, residence in the Northern region and diagnosis during 2019-2021 were associated with lower CSM.Conclusions: Lower MHI was independently associated with poorer survival in early GAC, highlighting persistent socioeconomic disparities in access to definitive treatment. Strategies to improve equitable access to curative therapy are warranted.","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"57 1","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastrointestinal Cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12029-026-01604-w","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: The influence of socioeconomic determinants of health on early gastric adenocarcinoma (GAC) remains understudied. We evaluated the association between median household income (MHI), treatment patterns, and survival in T1aN0M0 GAC.

Methods: Using the SEER-17 Research Plus database (2004-2021), we identified 3,792 patients with T1aN0M0 GAC. MHI was stratified into tertiles. Overall survival (OS), cancer-specific mortality (CSM), and non-cancer-specific mortality (NCSM) were assessed with Kaplan-Meier methods. Independent predictors of CSM were identified using multivariable Fine-Gray competing-risk regression.

Results: Patients in the lowest MHI tertile were younger, more likely to be Black, unemployed, and to receive no definitive treatment (surgery or endoscopic therapy (ET)) despite similar tumor size (all P < 0.001) vs higher tertiles. Treatment patterns varied by income: highest MHI patients were more likely to undergo ET, while lowest MHI patients more often received chemotherapy/radiation and no definitive therapy. Compared with the highest MHI group, the lowest MHI group had worse outcomes, with lower 5-year OS (82.3% vs. 86.0%) and higher 5-year CSM (17.6% vs. 13.6%; both P < 0.001). NCSM did not differ across income tertiles. Compared with the lowest MHI tertile, the middle (sHR 0.68, 95% CI 0.55-0.83; P < 0.001) and highest MHI tertiles (sHR 0.72, 95% CI 0.56-0.93; P = 0.011) were associated with significantly lower CSM. Older age ( ≥ 65 years), tumor size ≥ 2 cm, poor tumor differentiation, no definitive treatment, and receipt of radiation therapy were independently associated with higher CSM, whereas Asian or Pacific Islander race, residence in the Northern region and diagnosis during 2019-2021 were associated with lower CSM.

Conclusions: Lower MHI was independently associated with poorer survival in early GAC, highlighting persistent socioeconomic disparities in access to definitive treatment. Strategies to improve equitable access to curative therapy are warranted.

查看原文本刊更多论文

社会经济地位对早期胃癌结局和治疗差异的影响：一项SEER分析。

目的：健康的社会经济决定因素对早期胃腺癌（GAC）的影响仍未得到充分研究。我们评估了T1aN0M0 GAC中位家庭收入（MHI）、治疗模式和生存率之间的关系。方法：使用SEER-17 Research Plus数据库（2004-2021），我们确定了3,792例T1aN0M0 GAC患者。将MHI分层成几层。采用Kaplan-Meier方法评估总生存率（OS）、癌症特异性死亡率（CSM）和非癌症特异性死亡率（NCSM）。使用多变量细灰色竞争风险回归确定CSM的独立预测因子。结果：MHI最低的患者更年轻，更可能是黑人，失业，尽管肿瘤大小相似，但没有接受明确的治疗（手术或内窥镜治疗（ET））。结论：较低的MHI与早期GAC较差的生存率独立相关，突出了在获得最终治疗方面持续存在的社会经济差异。改善公平获得治疗的战略是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.