Persistent poverty impacts access to minimally invasive surgery among patients with hepatopancreatobiliary cancer

Author:

Rawicz‐Pruszyński Karol12,Woldesenbet Selamawit1,Endo Yutaka1,Munir Muhammad M.1,Katayama Erryk1,Waqar Usama1,Khan Muhammad Muntazir Mehdi1,Khalil Mujtaba1,Rueda Belisario Ortiz1,Resende Vivian1,Dillhoff Mary1,Cloyd Jordan1,Ejaz Aslam1ORCID,Pawlik Timothy M.1ORCID

Affiliation:

1. Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA

2. Department of Surgical Oncology Medical University of Lublin Lublin Poland

Abstract

AbstractBackground and ObjectivesMinimally invasive surgery (MIS) has been successfully adopted in hepatopancreatobiliary (HPB) cancer, and has been associated with improved perioperative and comparable oncological outcomes. We sought to define the impact of county‐level duration of poverty on access to MIS and clinical outcomes among patients with HPB cancer undergoing surgical treatment.Materials and MethodsData on patients diagnosed with HPB cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare data (2010–2016). County‐level poverty data were obtained from the American Community Survey and the U.S. Department of Agriculture, and categorized into three groups: never high poverty (NHP), intermittent high poverty (IHP), and persistent poverty (PP). Multivariable regression was used to assess the relationship between PP and MIS.ResultsAmong 8098 patients, 82% (n = 664) resided in regions with NHP, 13.6% (n = 1104) resided in regions with IHP, and 4.4% (n = 350) resided in regions with PP. Median age at the diagnosis was 71 years (interquartile range [IQR]: 67–77). Patients from IHP and PP counties had lower odds of undergoing MIS (IHP/PP vs. NHP, odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.36–0.96, p = 0.034) and being discharged home (IHP/PP vs. NHP, OR: 0.64, 95% CI: 0.43–0.99, p = 0.043), as well as a higher risk of 1‐year mortality (IHP/PP vs. NHP, HR: 1.51, 95% CI: 1.036–2.209, p = 0.032) compared with patients residing in NHP counties.ConclusionsDuration of county‐level poverty was associated with lower receipt of MIS and unfavorable clinical and survival outcomes among patients with HPB cancer. There is a need to improve access to modern surgical treatment options among vulnerable, PP populations.

Publisher

Wiley

Subject

Oncology,General Medicine,Surgery

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Poverty and Its Impact on Surgical Care;Advances in Surgery;2024-09

2. Poverty Traps and Mortality From Liver Diseases in the United States;American Journal of Gastroenterology;2024-06-25

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