Survival Disparities in Early-Onset Pancreatic Cancer (EOPC): The Role of Socioeconomic Status and Healthcare Access.

[INTRODUCTION] Early-onset pancreatic cancer (EOPC), defined as pancreatic ductal adenocarcinoma (PDAC) diagnosed at or before age 50, is an increasingly recognized clinical entity with a rising incidence. Despite advancements in treatment, socioeconomic status (SES) disparities have impacted access to care and survival. This study examined the relationship between SES and survival in EOPC.

[METHODS] Data from the National Cancer Database (2004-2022) were analyzed for patients diagnosed with EOPC. SES was determined using a composite measure incorporating education and income levels and was categorized into four quartiles. Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling were used to assess survival differences across the SES groups.

[RESULTS] A total of 10,729 patients with EOPC were included, with 24.0% in the low SES group, 29.9% in mid-low SES, 30.3% in mid-high SES, and 15.8% in high SES. Higher SES was associated with increased access to multimodal therapy, including neoadjuvant and adjuvant chemotherapy, radiation, and surgical resection (p < 0.001). Private insurance coverage was significantly higher in the high-SES group (81.1% vs. 50.2% in the low-SES group, p < 0.001). Multivariable Cox regression showed that patients in the high-SES group had a significantly lower risk of mortality (HR = 0.71, 95% CI: 0.54-0.83; p = 0.033). The median survival increased from 9 months in the low SES group to 12 months in the high SES group (p < 0.001). Kaplan-Meier analysis showed that survival differences by SES were most pronounced in advanced-stage disease, particularly in stage III (p = 0.017) and stage IV (p < 0.001) cancers.

[CONCLUSION] Lower SES was consistently linked to worse EOPC survival, particularly in advanced stages. Addressing SES-related disparities through targeted interventions and healthcare policy reforms could improve outcomes across all disease stages. Further research into the unique tumor biology and molecular characteristics of EOPC is needed to better understand how SES influences disease progression and treatment response.