Impact of Race, Insurance Status, and Primary Language on Patients with Pancreatic Adenocarcinoma at an Urban, Academic, Safety-Net Medical Center.
*Praveen Sridhar, *Priya Misir, David B. McAneny, *Susanna de Geus, Jennifer F Tseng, *Teviah E Sachs
Boston University, Boston, MA
Objective: To examine the impact of demographics and socioeconomic status (SES) on pancreatic adenocarcinoma (PA) patients in a unique setting.
Design: Demographics, tumor characteristics, treatment, and survival were analyzed for patients diagnosed with PA (1/2006 - 12/2017). Chi square and Kaplan Meier survival analysis were employed.
Setting: Patients were diagnosed and treated for PA at a single, high minority, urban, safety-net hospital.
Patients: We identified 240 patients, of whom 48% were minority race, 22% were non-English speaking and 84.5% had Medicaid/Medicare insurance.
Interventions: Patients were treated using chemotherapy, radiation therapy, curative surgery, and palliative therapy or surgery.
Main Outcome Measures: Overall survival, stage at presentation, time-to-intervention were examined.
Results: More black patients than white patients were enrolled in Medicaid (61% vs 31%; P<.01). Half of patients (47%) were Stage IV, of whom 15% declined treatment. One-third (29.3%) underwent surgical resection (Stage I: 15%, Stage II: 80%) while 21.8% with early stage tumors were medically unfit or declined surgery. Neoadjuvant therapy was given to 27% of patients. Minority patients presented at similar stage as white patients. More privately insured patients (43%) presented at early stage than did Medicaid (28%) or Medicare (34%) patients, though not statistically significant (p=.342). Insurance status (Medicare, Medicaid or Private) played no role in rates of resection (31%/23.7%/35%; P=.86) or adjuvant therapy (89%/72.3%/100%; P=.26). Neither stage-specific survival nor time-to-intervention differed based on race, ethnicity, insurance or language. Conclusions: We found no differences in the timing and delivery of care or survival, even with a high volume of racial minority and non-English speaking patients. Further evaluation of other safety-net hospitals may improve the overall care of disadvantaged patients.
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