Abstract
Background
Pancreatic adenocarcinoma (PAC) has one of the highest mortality rates among all malignancies.
While previous research has analyzed socioeconomic factors’ effect on PAC survival,
outcomes of Medicaid patients are understudied.
Methods
Using the SEER-Medicaid database, we studied non-elderly, adult patients with primary
PAC diagnosed between 2006 and 2013. Five-year disease-specific survival analysis
was performed using the Kaplan-Meier method and adjusted analysis using Cox proportional-hazards
regression.
Results
Among 15,549 patients (1799 Medicaid, 13,750 non-Medicaid), Medicaid patients were
less likely to receive surgery (p < .001) and more likely to be non-White (p < .001).
The 5-year survival of non-Medicaid patients (8.13%, 274 days [270–280]) was significantly
higher than that of Medicaid patients (4.97%, 152 days, [151–182], p < .001). Among
Medicaid patients, those in high poverty areas had significantly lower survival rates
(152 days [122–154]) than those in medium poverty areas (182 days [157–213], p = .008).
However, non-White (152 days [150–182]) and White Medicaid patients (152 days [150–182])
had similar survival (p = .812). On adjusted analysis, Medicaid patients were still
associated with a significantly higher risk of mortality (aHR 1.33 [1.26–1.41], p < .0001)
compared to non-Medicaid patients. Unmarried status and rurality were associated with
a higher risk of mortality (p < .001).
Discussion
Medicaid enrollment prior to PAC diagnosis was generally associated with a higher
risk of disease-specific mortality. While there was no difference in the survival
between White and non-White Medicaid patients, Medicaid patients living in high poverty
areas were shown to be associated with poor survival.
Keywords
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Article info
Publication history
Published online: February 12, 2023
Accepted:
February 8,
2023
Received in revised form:
January 20,
2023
Received:
November 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
