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Association between the Environmental Quality Index and Textbook Outcomes Among Medicare Beneficiaries Undergoing Surgery for Early-Stage Pancreatic Adenocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Access to high-quality cancer care is affected by environmental exposures and structural inequities. This study sought to investigate the association between the environmental quality index (EQI) and achievement of textbook outcomes (TO) among Medicare beneficiaries over the age of 65 who underwent surgical resection for early-stage pancreatic adenocarcinoma (PDAC).

Methods

Patients diagnosed with early-stage PDAC from 2004 to 2015 were identified using the SEER-Medicare database and combined with the US Environmental Protection Agency’s EQI data. High EQI category indicated poor environmental quality, whereas low EQI indicated better environmental conditions.

Results

A total of 5,310 patients were included, of which 45.0% (n = 2,387) patients achieved TO. Median age was 73 years and more than half were female (n = 2,807, 52.9%), married (n = 3,280, 61.8%), and resided in the Western region of the US (n = 2,712, 51.1%). On multivariable analysis, patients residing in moderate and high EQI counties were less likely to achieve a TO (referent: low EQI; moderate EQI: OR 0.66, 95% CI 0.46–0.95; high EQI: OR 0.65, 95% CI 0.45–0.94; p < 0.05). Increasing age (OR 0.98, 95%CI 0.97–0.99), racial minorities (OR 0.73, 95% CI 0.63–0.85), having a Charlson co-morbidity index > 2 (OR 0.54, 95%CI 0.47–0.61) and stage II disease (OR 0.82, 95%CI 0.71–0.96) were also associated with not achieving a TO (all p < 0.001).

Conclusion

Older Medicare patients residing in moderate or high EQI counties were less likely to achieve an “optimal” TO after surgery. These results demonstrate that environmental factors may drive post-operative outcomes among patients with PDAC.

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Acknowledgements

The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

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  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Chanza F. Shaikh, Selamawit Woldesenbet, Muhammad Musaab Munir, Zorays Moazzam, Yutaka Endo, Laura Alaimo, Lovette Azap, Jason Yang, Erryk Katayama, Henrique A. Lima, Zaiba Dawood & Timothy M. Pawlik

  2. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Suite 670, Columbus, OH, USA

    Timothy M. Pawlik

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Shaikh, C.F., Woldesenbet, S., Munir, M.M. et al. Association between the Environmental Quality Index and Textbook Outcomes Among Medicare Beneficiaries Undergoing Surgery for Early-Stage Pancreatic Adenocarcinoma. J Gastrointest Surg 27, 1883–1892 (2023). https://doi.org/10.1007/s11605-023-05757-y

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