ArticleFrontiers in public health2026
Impact of small area-level deprivation on survival outcomes in patients with Cholangiocarcinoma: a population-based multilevel survival analysis.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cholangiocarcinoma (CCA) carries a dismal prognosis. Beyond clinical determinants, socioeconomic deprivation may also influence outcomes. Busan, a rapidly aging metropolitan area in Korea, provides a critical setting for evaluating how area-level deprivation interacts with individual risk factors for CCA survival. However, evidence regarding the effect of area-level deprivation on CCA survival remains scarce, particularly within the Korean population. We aimed to evaluate the association between the deprivation index (DI) and individual clinical factors and provide a deeper understanding of the variability in the survival rates of patients with CCA in Busan. Methods: We analyzed data from 12,950 patients diagnosed with CCA between 2003 and 2020 using the Busan Regional Cancer Registry linked with national death records. Individual-level variables included age, sex, stage, and year of diagnosis, while area-level deprivation was quantified using the census-derived DI. Multilevel survival analyses were performed using a frailty Cox proportional hazards model with a random intercept for region to estimate hazard ratios (HRs) for both individual- and regional-level predictors. Results: The median survival period was 42 weeks. Survival declined with age (46.5% vs. 21.3% in patients aged 0-44 years and ≥75 years, respectively, Conclusion: CCA survival in Busan is influenced by both individual vulnerability and area-level deprivation. Older age, advanced stage, and higher deprivation were identified as independent poor prognostic factors for CCA survival. In super-aged urban societies, integrating social determinants into clinical care is essential to reduce inequities and improve outcomes.
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