Association of neighborhood-level factors with access to genetic testing in patients with resectable pancreatic ductal adenocarcinoma.

Abstract

4196 Background: Since 2019, the NCCN has recommended genetic testing for all patients with pancreatic ductal adenocarcinoma (PDAC). However, only one-third of patients undergo testing. For other cancers, social determinants of health have been shown to influence access to genetic testing. This study examines disparities in genetic testing among PDAC patients using neighborhood-level measures. Methods: We retrospectively analyzed 249 patients who underwent curative-intent resection for PDAC at a high-volume academic center between 2019 and 2023. Neighborhood disadvantage was quantified using the Area Deprivation Index (ADI). Additional socioeconomic variables included Rural-Urban Classification (RUCA) codes, insurance type (private vs. non-private), and distance to the treating facility. The primary outcome was completion of genetic testing. For those that did not undergo testing, we separately analysed the association between socioeconomic factors and presence of a referral for genetic counseling or testing. Logistic regression models adjusted for age, sex, and period of diagnosis were used to assess associations. Results: The cohort’s mean age was 66.6 years (SD: 9.2); 45.1% were female, and 97.6% identified as non-Hispanic White. Median ADI was 55.0 (IQR: 29.5), and 38.1% lived in rural areas. Genetic testing was completed by 96 patients (40.1%), identifying pathogenic variants in 18 (18.7%). Multivariable analysis revealed age above 65, higher ADI, and greater distance from the facility significantly reduced testing likelihood. Testing rates increased between 2019 and 2023 (Table 1). Among the 153 patients without testing, only 41.2% were referred for genetic counseling/testing. Greater distance from the facility was associated with lower likelihood of being referred (OR: 0.33 [CI: 0.13, 0.85]). Conclusions: Neighborhood-level factors influence genetic testing access, even in a predominantly racially homogenous population. Targeted interventions are needed to reduce disparities and improve testing and referral rates. Univariable and multivariable logistic regression for association of socioeconomic factors with completion of testing. Univariable Multivariable* Factor OR [95% CI] OR [95% CI] ADI (continuous)Urban residence (ref: Rural) 0.12 [0.04, 0.46]*0.61 [0.34, 1.04] 0.15 [0.02, 0.97]*0.97 [0.50, 1.90] Distance to facility (ref: Low, <33) Moderate, 33–61 0.49 [0.26, 0.93]* 0.75 [0.34, 1.65] High, ≥ 61 0.31 [0.17, 0.56]* 0.45 [0.21, 0.99]* Age ≥ 65 (ref:<65)Female Sex (ref: Male)Non-private insurance (ref: Private)Period of diagnosis (ref: 2019-2020) 2023 0.81 [0.50, 1.31]1.05 [0.68, 1.62]0.77 [0.46, 1.28]7.32 [3.63, 14.78]* 0.50 [0/26, 0.94]*1.08 [0.57, 2.04]1.13 [0.63, 2.01]7.37 [3.52, 15.43]* *Statistically significant. Adjusted for age, sex, insurance status, and period of diagnosis.