Race, Socioeconomic Status, Treatment, and Survival Time among Pancreatic Cancer Cases in California

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 16; no. 3; pp. 546 - 552
• Main Authors: ZELL, Jason A, RHEE, Jessica M, ZIOGAS, Argyrios, LIPKIN, Steven M, ANTON-CULVER, Hoda
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 01-03-2007
• Subjects: Adenocarcinoma - epidemiology; Adenocarcinoma - ethnology; Adenocarcinoma - therapy; African Americans - statistics & numerical data; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; cancer in minority and medically underserved populations; Chi-Square Distribution; descriptive, risk factor, and methodologic studies; ethnicity; European Continental Ancestry Group - statistics & numerical data; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hispanic Americans - statistics & numerical data; Humans; Incidence; intraductal papillary mucinous neoplasm; IPMN; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; pancreatic cancer; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - ethnology; Pancreatic Neoplasms - therapy; Prognosis; Proportional Hazards Models; Registries; Retrospective Studies; Risk Factors; Social Class; survival; Survival Analysis; Tumors; California; United States; North America; America; Human; Ethnic origin; Prognosis; Socioeconomic status; Malignant tumor; Epidemiology; Survival; Cancerology; Treatment; Register; Pancreas cancer; Race; Digestive diseases; Public health; Social aspect; Pancreatic disease
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-06-0893

Background: Poor survival in pancreatic adenocarcinoma is associated with African-American race and also with low socioeconomic
status (SES). However, it is not known whether the observed poor survival of African-American pancreatic adenocarcinoma cases
is due to SES itself and/or treatment disparities. We set out to determine this using the large, population-based California
Cancer Registry (CCR) database as a model.
Methods: We conducted a case-only analysis of CCR data (1989-2003), including descriptive analysis of relevant clinical variables
and SES. The SES variable used has been derived from principle component analysis of census block level CCR data linked to
census data to address seven major indicators of SES. Overall survival univariate analyses were conducted using the Kaplan-Meier
method. Multivariate survival analyses were done using Cox proportional hazards ratios (HR).
Results: Incident cases of pancreatic cancer (24,735) were analyzed. Among adenocarcinomas, after adjustment for age, year
of diagnosis, and gender, African-Americans [HR, 1.14; 95% confidence interval (95% CI), 1.08-1.21] and Hispanics (HR, 1.06;
95% CI, 1.01-1.11) had an increased risk of death compared with Caucasians. These differences persisted after adjustment for
stage. However, after further adjustment for SES, surgery, radiation, and chemotherapy, the risk of death for African-Americans
(HR, 1.00; 95% CI, 0.94-1.06) and Hispanics (HR, 0.97; 95% CI, 0.93-1.02) was not statistically different from Caucasians.
Conclusions: Differences in treatment and SES likely account for the observed poor survival of African-Americans and Hispanics
among pancreatic adenocarcinoma cases. These data highlight the importance of improving access to care for ethnic minority
pancreatic cancer patients. (Cancer Epidemiol Biomarkers Prev 2007;16(3):546–52)