ArticleJournal of gastrointestinal cancer2026
Impact of Socioeconomic Status on Early Gastric Cancer Outcomes and Treatment Disparity: a SEER analysis.
Article in Journal of gastrointestinal cancer, 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
purposeThe influence of socioeconomic determinants of health on early gastric adenocarcinoma (GAC) remains understudied. We evaluated the association between median household income (MHI), treatment patterns, and survival in T1aN0M0 GAC.
methodsUsing the SEER-17 Research Plus database (2004-2021), we identified 3,792 patients with T1aN0M0 GAC. MHI was stratified into tertiles. Overall survival (OS), cancer-specific mortality (CSM), and non-cancer-specific mortality (NCSM) were assessed with Kaplan-Meier methods. Independent predictors of CSM were identified using multivariable Fine-Gray competing-risk regression.
resultsPatients in the lowest MHI tertile were younger, more likely to be Black, unemployed, and to receive no definitive treatment (surgery or endoscopic therapy (ET)) despite similar tumor size (all P < 0.001) vs higher tertiles. Treatment patterns varied by income: highest MHI patients were more likely to undergo ET, while lowest MHI patients more often received chemotherapy/radiation and no definitive therapy. Compared with the highest MHI group, the lowest MHI group had worse outcomes, with lower 5-year OS (82.3% vs. 86.0%) and higher 5-year CSM (17.6% vs. 13.6%; both P < 0.001). NCSM did not differ across income tertiles. Compared with the lowest MHI tertile, the middle (sHR 0.68, 95% CI 0.55-0.83; P < 0.001) and highest MHI tertiles (sHR 0.72, 95% CI 0.56-0.93; P = 0.011) were associated with significantly lower CSM. Older age ( ≥ 65 years), tumor size ≥ 2 cm, poor tumor differentiation, no definitive treatment, and receipt of radiation therapy were independently associated with higher CSM, whereas Asian or Pacific Islander race, residence in the Northern region and diagnosis during 2019-2021 were associated with lower CSM.
conclusionsLower MHI was independently associated with poorer survival in early GAC, highlighting persistent socioeconomic disparities in access to definitive treatment. Strategies to improve equitable access to curative therapy are warranted.
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