Association Between Socioeconomic and Insurance Status and Delayed Diagnosis of Gastrointestinal Cancers.
Cancer diagnosis
Delayed diagnosis
Disparities
Gastrointestinal cancers
Socioeconomic status
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
16
08
2021
revised:
10
04
2022
accepted:
21
05
2022
pubmed:
3
7
2022
medline:
24
9
2022
entrez:
2
7
2022
Statut:
ppublish
Résumé
Association between socioeconomic status (SES) and stage at diagnosis in gastrointestinal (GI) cancers is poorly described. Relationship between low SES and stage at diagnosis as well as the mediating role of insurance status (IS) was examined. The Surveillance, Epidemiology, and End Results database was queried for esophageal, gastric, liver, biliary, pancreatic, colon, and rectal cancers diagnosed in 2012-2016. Relationship between census-tract SES index quintiles and late diagnosis (distant disease at diagnosis) was examined. Uni and multivariable logistic regressions were performed. Mediation analyses were conducted to determine the degree to which IS (private/Medicare versus Medicaid/uninsured) mediates the relationship between SES and late diagnosis of cancer. Analysis included 236,713 adult patients from 18 Surveillance, Epidemiology, and End Results areas. In univariable analysis, lowest SES quintile was significantly associated with late diagnosis for all cancers except gastric and biliary cancers. In multivariable analysis controlling for age, gender, marital status and race, this association remained significant for liver (odds ratio (OR) 1.41 [95% confidence interval (CI) 1.25-1.58]), pancreatic (OR 1.13 [95% CI 1.06-1.21]), and rectal (OR 1.31 [95% CI 1.20-1.42]) cancers. Further controlling for IS showed the largest effect size reduction for rectal cancer (OR 1.18 [95% CI 1.09-1.29]), with IS mediating 36.5% (P < 0.0001) of SES effect. Low SES is an independent risk factor for late diagnosis in liver, pancreas, and rectal cancers. Insurance is not a critical mediator of difference by SES for most GI cancers, with the exception of rectal cancer. Further research is needed to understand factors beyond IS that can account for SES differences in late diagnosis for GI cancers. Insurance related differences for rectal cancer deserves further attention.
Identifiants
pubmed: 35779447
pii: S0022-4804(22)00344-4
doi: 10.1016/j.jss.2022.05.027
pmc: PMC10132254
mid: NIHMS1888146
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
170-186Subventions
Organisme : NCI NIH HHS
ID : P30 CA013330
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA200561
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002556
Pays : United States
Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.
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