Disparities in Surgical Treatment of Resectable Pancreatic Adenocarcinoma at Minority Serving Hospitals

Minority serving hospitals (MSH) are those serving a disproportionally high number of minority patients. Previous research has demonstrated that treatment at MSH is associated with worse outcomes. We hypothesize that patients treated at MSH are less likely to undergo surgical resection of pancreatic...

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Bibliographic Details
Published in:	The Journal of surgical research Vol. 294; pp. 160 - 168
Main Authors:	Olecki, Elizabeth J., Perez Holguin, Rolfy A., Mayhew, Mackenzie M., Wong, William G., Vining, Charles C., Peng, June S., Shen, Chan, Dixon, Matthew E.B.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-02-2024
Subjects:	Adenocarcinoma - epidemiology Adenocarcinoma - ethnology Adenocarcinoma - mortality Adenocarcinoma - surgery Black People Disparities Healthcare Disparities - ethnology Healthcare Disparities - statistics & numerical data Hispanic or Latino - statistics & numerical data Hospitals - statistics & numerical data Humans Minority serving hospital Pancreatic adenocarcinoma Pancreatic Neoplasms - epidemiology Pancreatic Neoplasms - ethnology Pancreatic Neoplasms - mortality Pancreatic Neoplasms - surgery Retrospective Studies Pancreatic adenocarcinoma Minority serving hospital Disparities
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Summary:	Minority serving hospitals (MSH) are those serving a disproportionally high number of minority patients. Previous research has demonstrated that treatment at MSH is associated with worse outcomes. We hypothesize that patients treated at MSH are less likely to undergo surgical resection of pancreatic adenocarcinoma compared to patients treated at non-MSH. Patients with resectable pancreatic cancer were identified using the National Cancer Database. Institutions treating Black and Hispanic patients in the top decile were categorized as an MSH. Factors associated with the primary outcome of definitive surgical resection were evaluated using multivariable logistic regression. Univariate and multivariable survival analysis was performed. Of the 75,513 patients included in this study, 7.2% were treated at MSH. Patients treated at MSH were younger, more likely to be uninsured, and higher stage compared to those treated at non-MSH (P < 0.001). Patients treated at MSH underwent surgical resection at lower rates (MSH 40% versus non-MSH 44.5%, P < 0.001). On multivariable logistic regression, treatment at MSH was associated with decreased likelihood of undergoing definitive surgery (odds ratio 0.91, P = 0.006). Of those who underwent surgical resection, multivariable survival analysis revealed that treatment at an MSH was associated with increased morality (hazard ratio 1.12, P < 0.001). Patients with resectable pancreatic adenocarcinoma treated at MSH are less likely to undergo surgical resection compared to those treated at non-MSH. Targeted interventions are needed to address the unique barriers facing MSH facilities in providing care to patients with pancreatic adenocarcinoma.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0022-4804 1095-8673 1095-8673
DOI:	10.1016/j.jss.2023.09.066