Geographic Variations in Demographic, Stage at Diagnosis and Socioeconomic Profiles of Pancreatic Cancer Patients in the United States: A National Cancer Database Analysis (2004-2020)
TL;DR
Patients with pancreatic cancer across the United States show significant demographic and socioeconomic differences, with only modest variation in stage at diagnosis, suggesting that, unlike many screen-detectable malignancies, socioeconomic disadvantage primarily influences access to timely treatment and specialty care rather than early detection.
Abstract
Background/Aim: Pancreatic cancer remains one of the most fatal malignancies worldwide, mainly because most patients present with advanced disease; however, little is known about regional variations in patient demographics, socioeconomic-status and stage at diagnosis. This study evaluated these variations to improve early detection and equitable healthcare delivery. Patients and Methods: This cross-sectional study analyzed National Cancer Database (NCDB) data on patients with pancreatic cancer between 2004 and 2020. Patients were divided into six geographic regions of the United States: Northeast, Southeast, Midwest, Southwest, Mountain, and Pacific, based on treating hospital location. Regional patient characteristics were compared, including age, sex, race and ethnicity, insurance type, income, city versus rural residence, and American Joint Committee on Cancer (AJCC) cancer-stage. Results: Among 1,043,035 patients (mean age, 69.0 years; 50.9% male) significant regional differences were observed. Blacks were prevalent in Southeast (19.9%) and Southwest (16.5%) cohorts compared with 2.6% in the mountain regions. Asians were prevalent in the Pacific region (11.5%), while Hispanics were concentrated in the Pacific (11.5%) and Southwest (7.1%) regions. Lower-income households (< $63,000) were most common in the Southwest (82.0%) and Southeast (73.7%). In contrast, the Northeast region had higher-income households (49.3%) and metropolitan residents (91.8%). Overall, 51.4% of patients were diagnosed at stage IV, highlighting late-stage presentation as a universal challenge, irrespective of demographic and socioeconomic composition. Conclusion: Patients with pancreatic cancer across the United States show significant demographic and socioeconomic differences, with only modest variation in stage at diagnosis. These findings suggest that, unlike many screen-detectable malignancies, socioeconomic disadvantage primarily influences access to timely treatment and specialty care rather than early detection. Targeted interventions are needed to improve equitable access to multidisciplinary pancreatic cancer care.