Racial disparities in receipt of guideline concordant pancreatic cancer care among older adults in the US.

Abstract

679 Background: Patients racialized as Black experience higher incidence and mortality from pancreatic cancer (PC). The aim of this study was to examine differences in receipt of guideline concordant care (GCC) among older adults with PC racialized as Black, White, or Hispanic ethnicity. Methods: Patients 65 years and older with incident PC racialized as White, Black, or Hispanic ethnicity were identified in the SEER-Medicare database from 2004-2019. The primary outcome was receipt of GCC (stage I/II: surgery+chemotherapy+/-radiation; stage III: chemotherapy+/-surgery+/-radiation; stage IV: chemotherapy+/-radiation). Multivariable logistic regression was used to identify factors associated with GCC. Oaxaca-Blinder decomposition was used to examine the contribution of measured and unmeasured variables to racial disparities in receipt of GCC. Results: Of 12,772 patients included, 85.5% of patients racialized as White (n=10,915), 7.8% Black (n=992), and 6.8% Hispanic ethnicity (n=865). Patients racialized as Hispanic ethnicity and Black were more often dual-eligible for Medicare/Medicaid than patients racialized as White (38.6%, 26.9%, and 7.5%, respectively). In total, 56.3% received GCC. On adjusted analysis, patients racialized as Black were less likely to receive GCC for early stage (stage I/II) disease compared to patients racialized as White (OR 0.66; 95% CI 0.53-0.83), but not for stage III (OR 0.65; 95% CI 0.41-1.01) or stage IV (OR 0.87; 95% CI 0.66-1.14) disease. No difference in GCC was observed among patients of Hispanic ethnicity when compared to patients racialized as White. Increased age and dual-eligibility were associated with decreased likelihood of GCC across stages. Differences in receipt of GCC among patients racialized as Black and White remain largely unexplained. Of the measured factors, comorbidities, dual-eligibility, and area level poverty contributed most to the disparity in GCC (Table). Conclusions: Just over half of an insured population with PC receive GCC. Despite an increased focus on equity in cancer care, Black-White racial disparities in receipt of GCC are prevalent, particularly among patients with early-stage disease. Further studies are critical to identify and address the unmeasured factors driving treatment disparities. Contributing factors to racial disparities in guideline concordant care for patients with pancreatic cancer. Stage I/II Stage III Stage IV Difference (White-Black) 11.6% 9.4% 4.1% Explained Age -3.0% -2.0% -1.0% Sex 0.1% 0.8% 0.1% Dual-Eligibility 2.0% 3.1% 0.8% Charlson Comorbidity Index 1.3% 0.2% 0.7% Area Level Poverty 2.2% -0.8% 0.7% Hospital/Practice Volume 1.2% -0.3% -0.03% Region 0.4% 0.9% -0.2% Year of Diagnosis -0.1% 0.5% 0.1% Unexplained 7.5% 7.0% 3.0% Positive values indicate these factors increased the measured disparity, while negative values indicate these decreased the measured disparity.