BACKGROUND: Pancreatic ductal adenocarcinoma maintains a formidable mortality rate with rising incidence despite extensive research efforts. As of 2021 pancreatic cancer is the third leading cause of cancer-related deaths in the United States despite its incidence representing only 3% of all cancer diagnoses. Given the high mortality rate, research efforts push to improve prognosis by expanding knowledge and tools in the realms of diagnostics, genetics, development of screening modalities, and targeted treatments. Modifications in treatment algorithms have led to only modest improvements in outcome. Current research efforts focus on primary and secondary prevention aimed at modifications of known environmental and hereditary risk factors. Available studies highlight the relationship between relative geography and cancers; however, there is a paucity of research available on the Social Determinants of Health on access to pancreatic cancer care and outcomes.
PROPOSED PROJECT: Data will be extracted from the Surveillance, Epidemiology, and End Results (SEER) database and combined with US Census data along with medical record information as relevant over a seven-year period from January 1, 2010, through December 31, 2017. Social Vulnerability Index scores will be derived from the available data as a surrogate for Social Determinant of Health and be assigned to each case of pancreatic cancer from 2010-2017. These scores will be grouped by zip code. Analysis will then be performed to identify the mean stage at time of diagnosis for each zip code. Further analysis will be performed to calculate survival curves for each zip code and cox proportional-hazards will be performed on results to determine statistical significance of SVI with respect to geography.
CONCLUSIONS: The proposed study will investigate the impact of geography as a Social Determinant of Health (SDoH) within the United States on the stage at time of diagnosis for pancreatic ductal adenocarcinoma. As a secondary measure, overall survival following diagnosis of pancreatic ductal adenocarcinoma will be examined.
SIGNIFICANCE: This study will identify the impact of social determinants of health on geography and correlate the impact on outcomes in pancreatic ductal adenocarcinoma in the United States of America. This study may also identify geographic regions in which the incidence of PDAC is higher than expected which would present a population to investigate for additional screening studies and development of risk prediction models.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45829 |
| Date | 24 March 2023 |
| Creators | Patri, Gabrielle A. |
| Contributors | Meade, Sarah, Weinstein, John |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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