J. Bazemore1, Z. Sing1, C. Wu1, H. Chen1, J. Rose1, S. Bhatia2, A. Gillis1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2University Of Alabama at Birmingham, Department Of Pediatrics, Birmingham, Alabama, USA
Introduction: Pancreatic neoplasms primarily affect older patients. Black and older patients have lower survival rates from pancreatic neoplasms than their White and younger patients, even after adjusting for comorbidities. Little research is focused solely on how social determinants of health (SDOH) may drive disparities particularly in older minorities. This study aims to assess and understand self-reported racial differences in exposure to adverse SDOH that may drive disparities in older patients with pancreatic neoplasm.
Methods: We performed a retrospective cohort study utilizing the data from NIH All of Us Research Program (2018-2022). This program consists of patient-volunteered electronic health record (EHR) data and surveys. We identified patients 65 years and older diagnosed with pancreatic neoplasms (including malignant and other tumors). We collected patient demographics along the Healthy People 2030 SDOH Domains Framework including highest educational level, marital status, annual income, and homeowner status from the Healthcare Access & Utilization and the SDOH surveys. Patients were categorized by their self-reported race as: Black/African American (BAA) or White/Caucasian (WC). Chi-squared tests were used to carry out descriptive analysis.
Results: This study included 1850 patients; 236 (12.8%) were BAA and 1614 (87.2%) were WC. The BAA group was younger with a mean (SD) age of 69 compared to WC mean age of 71 (p<0.001). BAA had a stronger female preponderance (64% vs 56%) female (p<0.01). BAA patients were more likely to rate their overall physical health as “poor/fair” compared to WC patients (48% vs. 25%, P<0.001). The BAA group had 58 (25%) with malignant tumors and the WC group had 357 (22%) with malignant tumors.
Socioeconomic status differed among cohorts, with BAA patients less likely to report education above high school (56% vs. 85%, P<0.001), annual income >50k (17% vs. 54%, P<0.001), home ownership (38% vs. 77%, P<0.001), and marriage (23% vs. 61%, P<0.001). BAA were more likely to report feeling that their doctor doesn’t listen to what they’re saying (41% vs. 20%, P<0.001). Barriers to health care also differed between groups with BAA patients were less likely to report having someone to take them to the doctor if needed (83% vs. 95% P=0.005). BAA patients were more likely to report delayed medical care due to unaffordable prescription medicines (18% vs. 8%, P=0.003).
Conclusion: Disparities exist in self-reported perception of health status and barriers to healthcare among older BAA patients with pancreatic neoplasms. The differences in SDOH between the racial groups may influence the known worse outcomes in older BAA patients.