title: Association of socio-economic status and stage of pancreatic cancer at time of surgery in a German setting.
abstract: OBJECTIVE
  Curative resection has been proven to be one of the most important factors determining outcome in pancreatic cancer patients. Advanced stage of pancreatic cancer at diagnosis is strongly associated with a low socioeconomic status (SES), and patients from affluent areas have better cancer survival than patients from deprived areas. We tested, in our population of pancreatic cancer patients, the hypothesis that surrogates representing a lower SES or demographic factors (DGF) linked to rural areas are associated with a more advanced disease stage at presentation.
  
  
  METHODS
  Between 1989 and 2008, patients with pancreatic adenocarcinoma and pancreaticoduodenectomy were identified from our pancreatic resection database. DGF, SES surrogates and tumor stage were obtained from patients' files together with pathology reports, a residents' registration office questionnaire and telephone interviews with patients and family members.
  
  
  RESULTS
  Follow-up was completed in 117 patients. There were no significant differences regarding tumor stage (local size and lymph node metastases), or the likelihood of negative resection margins in relation to the patients' DGF or any surrogate parameters for SES. Furthermore, comparison of two different treatment periods showed no significant advances regarding secondary cancer prevention within 20 years.
  
  
  CONCLUSIONS
  Longer waiting times for appointments combined with less sensitive imaging techniques and consecutive later referral to a cancer specialist are likely to be associated with inferior quality of medical results. Therefore, a lively debate is currently underway in Germany concerning the harmonization of reimbursement modes for statutory and private health insurance. Our data with no negative correlation of low SES or unfavorable DGF and disease stage at time of presentation or the likelihood for a curative resection, do not promote the universal accusation of health care disparities solely based on economic issues in Germany.
authors.affiliation: Department of Surgery, University of Bonn Medical Center, Bonn, Germany. standop@uni-bonn.de
authors.forename: Jens
authors.initials: J
authors.lastname: Standop
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kuhn
authors.forename: Tim R
authors.initials: TR
authors.lastname: Glowka
authors.forename: Nico
authors.initials: N
authors.lastname: Schaefer
authors.forename: Marcus
authors.initials: M
authors.lastname: Overhaus
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirner
authors.forename: Jorg C
authors.initials: JC
authors.lastname: Kalff
mesh_terms: D000230:Adenocarcinoma / Q000191:economics / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D004651:Employment; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D007348:Insurance, Health; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000191:economics; D017149:Private Sector; D012017:Referral and Consultation; D012111:Residence Characteristics; D019035:Rural Health Services / Q000191:economics; D012959:Socioeconomic Factors; D013222:State Medicine; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014850:Waiting Lists