ArticleAnnals of surgical oncology2023
Disparities in Socioeconomic Factors Mediate the Impact of Racial Segregation Among Patients With Hepatopancreaticobiliary Cancer.
Article in Annals of surgical oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Social and Surgical Drivers of Survival in Colorectal Liver Metastases: An NCBD Analysis.Journal of surgical oncology · 2026Article
- Residential and Transplant Center Neighborhood Segregation and Live Donor Liver Transplant.JAMA network open · 2026Article
- County-Level Structural Racism Indices and Racial Disparities in Lung Cancer Care.JAMA network open · 2026Article
- Association Between Fragmentation of Care and Delivery of Adjuvant Chemotherapy in Patients Traveling to High-Volume Hospitals for Pancreatic Adenocarcinoma.Annals of surgical oncology · 2026Article
- Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States.Journal of racial and ethnic health disparities · 2025Article
- Days at Home After Cancer Surgery: Impact of Area Deprivation and Association with Long-Term Outcomes.Annals of surgical oncology · 2025Article
- Associations of Social Vulnerability and Race-Ethnicity With Gastrointestinal Cancers in the United States.Cancer medicine · 2025Article
- ASO Author Reflections: Contemporary Redlining-Direct and Mediating Effects on Healthcare Disparities Among Patients with Gastrointestinal Cancer.Annals of surgical oncology · 2025Article
- Impact of Contemporary Redlining on Healthcare Disparities Among Patients with Gastrointestinal Cancer: A Mediation Analysis.Annals of surgical oncology · 2025Article
- Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California.Annals of surgical oncology · 2024Article
- ASO Author Reflections: Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California.Annals of surgical oncology · 2024Article
- Importance of Diversity, Equity, and Inclusion in the Hepatopancreatobiliary Workforce.Cancers · 2024Review
- Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer.Cancers · 2023Article
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13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStructural racism within the U.S. health care system contributes to disparities in oncologic care. This study sought to examine the socioeconomic factors that underlie the impact of racial segregation on hepatopancreaticobiliary (HPB) cancer inequities.
methodsBoth Black and White patients who presented with HPB cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2005-2015) and 2010 Census data. The Index of Dissimilarity (IoD), a validated measure of segregation, was examined relative to cancer stage at diagnosis, surgical resection, and overall mortality. Principal component analysis and structural equation modeling were used to determine the mediating effect of socioeconomic factors.
resultsAmong 39,063 patients, 86.4 % (n = 33,749) were White and 13.6 % (n = 5314) were Black. Black patients were more likely to reside in segregated areas than White patients (IoD, 0.62 vs. 0.52; p < 0.05). Black patients in highly segregated areas were less likely to present with early-stage disease (relative risk [RR], 0.89; 95 % confidence interval [CI] 0.82-0.95) or undergo surgery for localized disease (RR, 0.81; 95% CI 0.70-0.91), and had greater mortality hazards (hazard ratio 1.12, 95% CI 1.06-1.17) than White patients in low segregation areas (all p < 0.05). Mediation analysis identified poverty, lack of insurance, education level, crowded living conditions, commute time, and supportive income as contributing to 25 % of the disparities in early-stage presentation. Average income, house price, and income mobility explained 17 % of the disparities in surgical resection. Notably, average income, house price, and income mobility mediated 59 % of the effect that racial segregation had on long-term survival.
conclusionRacial segregation, mediated through underlying socioeconomic factors, accounted for marked disparities in access to surgical care and outcomes for patients with HPB cancer.
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