C. Mosquera1, J. Lee1, S. D. Kachare1, T. L. Fitzgerald1, E. E. Zervos1 1East Carolina University Brody School Of Medicine,Division Of Surgical Oncology,Greenville, NC, USA
Introduction: The 29 county subregion comprising eastern North Carolina (ENC) is characterized by rurality, poverty and cancer outcome disparities when compared to the rest of the state. This study was undertaken to identify factors in this unique region contributing to disproportionately poor outcomes for pancreatic adenocarcinoma (PCA).
Methods: All patients diagnosed with PCA from 1996-2015 in ENC were identified through a central tumor registry. Logistic regression was undertaken to determine demographic, tumor, treatment and socioeconomic factors that contribute to observed outcome disparities.
Results:916 patients with PCA were identified, 93% of which arose from counties whose median household income is below the federal poverty limit. Compared to the rest of the state, PCA incidence in ENC (per 100k) is significantly higher (12.5 ±1.4 vs. 11.6 ± 1.7, p<0.03) as is the death rate (11.8±1.7 vs. 10.5±1.5, p<0.001). Multivariate analysis identified 7 factors independently predictive of poor survival (Table1). African Americans comprised 40% of these patients and were over-represented in each category that predicted poor outcomes.
Conclusion: Improved access to healthcare in ENC would positively impact 4 of 7 factors that are associated with poor survival in PCA; 3 are immutable. In this underserved population, Medicaid expansion or full implementation of the Affordable Care Act carries the greatest potential to erase these disparities.
