title: Socio-economic status influences the likelihood of undergoing surgical treatment for pancreatic cancer in the Netherlands.
abstract: Surgical resection offers the only prospect of cure in pancreatic cancer patients. The probability of undergoing surgery is determined by several factors. The influence of socio-economic status (SES) on surgical treatment and survival was investigated in the Netherlands, a country with a widely accessible healthcare system.
  
  
  
  Data on all patients with non-metastasised pancreatic cancer between 2005-2013 were analysed in the Eindhoven Cancer Registry (ECR). SES was categorized as low, intermediate or high. The influence of SES on the likelihood for surgery was assessed by multivariable logistic regression analyses. The influence on overall survival was analysed by multivariable Cox regression analyses.
  
  
  
  698 M0-patients were included, of whom 276 underwent surgery. Patients with low and intermediate SES were less likely to undergo surgery (32% vs 37%) than high-SES patients (48%) (p = 0.002; low SES: OR0.63, 95%CI [0.40-0.98]; intermediate SES: OR0.62, 95%CI [0.42-0.92]). Survival did not differ between SES groups (low SES: HR1.05 95%CI [0.85-1.30]; intermediate SES: HR1.11, 95%CI [0.91-1.35]), p = 0.181. SES in pancreatic cancer patients determined the likelihood for surgery. However, SES had no influence on survival. It is important to provide more insights in the causes of these inequalities to minimalize the effects of SES in pancreatic cancer care.
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
authors.forename: Maikel J A M
authors.initials: MJAM
authors.lastname: Bakens
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC Medical Center, Rotterdam, The Netherlands.
authors.forename: Valery E P P
authors.initials: VEPP
authors.lastname: Lemmens
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: Ignace.d.hingh@catharinaziekenhuis.nl.
authors.forename: Ignace H J T
authors.initials: IHJT
authors.lastname: de Hingh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome