title: Disparities in pancreas cancer care.
abstract: BACKGROUND
  Prior literature shows demographic differences in patients surgically treated for pancreatic cancer (PC). We hypothesized that socioeconomic disparities also exist across all aspects of PC care, in both surgically and non-surgically treated patients.
  
  
  METHODS
  We identified a cohort of patients with American Joint Committee on Cancer (AJCC) stage I-IV PC in the 1994-2008 California Cancer Registry. We used multivariate logistic regression to examine the impact of race, sex, and insurance status on (1) resectability (absence of advanced disease), (2) receipt of surgery, and (3) receipt of adjuvant/primary chemotherapy (+/- radiotherapy).
  
  
  RESULTS
  Among 20,312 patients, 7,585 (37 %) had resectable disease; 40 % who met this definition received surgery (N = 3,153). On multivariate analysis, males were less likely to present with resectable tumors [odds ratio (OR) 0.91, 95 % confidence interval (CI) 0.85-0.96], but sex did not otherwise predict treatment. Black patients were as likely as White patients to show resectable disease, yet were less likely to receive surgery (OR 0.66, 95 % CI 0.54-0.80), and adjuvant (OR 0.75, 95 % CI 0.58-0.98) or primary chemotherapy +/- radiation. Compared with Medicaid recipients, non-Medicare/Medicaid enrollees were more likely to receive surgery (OR 1.7, 95 % CI 1.4-2.2), and the uninsured were less likely to receive adjuvant therapy (OR 0.54, 95 % CI 0.30-0.98).
  
  
  CONCLUSIONS
  Though Black patients appear to present with comparable rates of resectability, they receive care that deviates from current guidelines. Insurance status is associated with inferior profiles of resectability and treatments. Future policies and research should identify effective strategies to ensure receipt of standard care.
authors.affiliation: The Minnesota Surgical Outcomes Workgroup, University of Minnesota Surgical Outcomes Research Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Anasooya
authors.initials: A
authors.lastname: Abraham
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.forename: Vikas
authors.initials: V
authors.lastname: Dudeja
authors.forename: Selwyn M
authors.initials: SM
authors.lastname: Vickers
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012042:Registries; D012737:Sex Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult