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Disparities in Surgical Oncologic Care

E145: Patients with Pancreatic Cancer Living in Racially Segregated Redlined Communities Have Worse Survival

Introduction: Redlining is a discriminatory practice classifying neighborhoods with racial minorities and low-income residents as “hazardous” to investment. Residential segregation by the Home Owners’ Loan Corporation (HOLC) via redlining influences patient cancer incidence and outcomes in breast, lung, cervical, and colorectal cancers. Here we investigate the influence of HOLC status on pancreatic cancer outcomes in Virginia.  

Methods: The Virginia Department of Health Cancer Registry was queried for adult patients diagnosed with primary pancreatic malignancy from 2009-2018. The HOLC grade (A: best, B: still desirable, C: definitely declining, D: hazardous) of each patient’s address was determined using the University of Richmond Inequality map. Patient demographics, treatment, and survival data were compared by HOLC Grade via descriptive statistics, bivariate and multivariate analysis. 

Results: 436 patients were identified (A: 26 (6.0%), B: 62 (14.2%), C: 218 (50.0%), D: 130 (29.8%)). There was no association between patient age, sex, insurance status, receipt of therapy, or smoking history and HOLC status.  Patient race was significantly associated with HOLC status with more Black patients living in areas with worse HOLC grades compared to White patients (p< 0.001). Survival analysis demonstrated that lack of surgery and chemotherapy (p< 0.001), and residential status in areas of HOLC grade D (p=0.024) were associated with worse survival. When comparing to patients living in HOLC D areas, patients who lived in areas with HOLC grade B (adjusted HR 0.65; CI 0.44-0.97) and C (adjusted HR 0.73; CI 0.56-0.95) had improved survival on Cox regression.

Conclusions: Historically redlined communities are fraught with socioeconomic disparities that can influence a patient’s healthcare and outcomes.  In Virginia, a patient’s home address is statistically associated with survival in pancreatic cancer where patients living in areas deemed “hazardous” have worse survival.  Future studies are warranted to further investigate this disparity in care.

Learning Objectives:

  • Upon completion, the participant will be able to define redlining and understand the HOLC grading system.
  • Upon completion, the participant will be able to describe how HOLC residential status is associated with other socioeconomic factors in patients with pancreatic cancer.
  • Upon completion, the participant will be to describe how residential status in a redlined area influences pancreatic cancer survival.