Annals of Surgical Oncology· 2026Q1
Association of Social Determinants of Health with Delays in Diagnosis and Treatment of Resected Pancreatic Ductal Adenocarcinoma (PDAC)
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- Q1SCImago
- 2026year
Short summary
Social determinants of health (SDoH), including insurance status, income, and education, are associated with delays in diagnosis and treatment initiation for resected pancreatic ductal adenocarcinoma (PDAC). Patients with Medicare insurance and those from lower-income areas experienced longer delays, while higher education correlated with faster diagnosis and treatment.
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Key points
- Social determinants of health (SDoH) like insurance, income, and education influence delays in PDAC diagnosis and treatment.
- Medicare insurance was associated with a 3.34x increased odds of delayed diagnosis compared to private insurance in the outpatient setting.
- Higher income was linked to an 84% reduction in delayed treatment odds.
- Higher education was associated with significantly reduced odds of both delayed diagnosis (OR 0.27) and treatment (OR 0.33) in the emergency room cohort.
- Alarm symptoms were found to reduce delays in both outpatient and emergency room settings.
AI-generated from the title and abstract; the full text is not read.
Abstract
Abstract Background Delayed diagnosis and treatment worsen survival in pancreatic ductal adenocarcinoma (PDAC). Despite many potential causes, the influence of social determinants of health (SDoH) is understudied. We evaluated whether SDoH impact delays in diagnosis and treatment among patients who underwent resection for PDAC. Patients and Methods Adults resected at a high-volume center were included (January 2016–November 2024). SDoH included insurance status, census-level income and education, rural–urban residence, and Area Deprivation Index. Primary endpoints were time from first imaging to histological diagnosis and time from first imaging to treatment initiation. Delay thresholds were derived using receiver operating characteristic analysis against overall survival. Uni- and multivariable logistic regression identified factors associated with delays, adjusting for demographic and clinical covariates, stratified by outpatient (OUP) versus emergency room (ER) presentation. Results Among 317 patients, the median age was 67 years, and 42.3% were female; 50.1% presented through ER. The median imaging-to-diagnosis interval was 11 days (interquartile [IQR] 3–27 days), and the median imaging-to-treatment interval was 40 days (IQR 27–59 days). In the OUP cohort, Medicare insurance was associated with delayed diagnosis compared with private insurance (OR 3.34 [95% CI 1.09–11.70]), whereas higher income was associated with up to 84% lower odds of delayed treatment. In the ER cohort, higher education was associated with reduced odds of delayed diagnosis (OR 0.27 [95% CI 0.07–0.88]) and delayed treatment (OR 0.33 [95% CI 0.11–0.91]). Post-endoscopic retrograde cholangiopancreatography (ERCP) hospitalization predicted delays in the ER setting, whereas alarm symptoms reduced delays in both settings. Conclusions SDoH are associated with diagnostic and treatment delays in resected PDAC. Targeted interventions may accelerate care and improve equity in outcomes.
The authors' abstract, as published at the source. Annals of Surgical Oncology, 2026 · DOI ↗
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Field: Oncology
OncologyMedicine