Abstract While individual-level social determinants of health are associated with pancreatic ductal adenocarcinoma (PDAC), it is currently unknown whether neighborhood-level socioeconomic disadvantage is related to the risk of PDAC diagnosis. Area deprivation index (ADI) is a validated tool to measure neighborhood-level disadvantage. We conducted a retrospective cohort study of 5,069,429 patients in the Veterans Health Administration (VA) between October 1, 2001-December 31, 2021. ADI percentiles were grouped using national ADI decile cutoffs. In multivariable analysis, the lowest ADI group, representing highest neighborhood-level socioeconomic status (SES), was associated with increased hazards for PDAC (adjusted HR, 1.13; 95% CI, 1.06-1.21) compared to those with median ADI percentiles. Differences in PDAC hazards were not seen in the other ADI percentiles. These results suggest that within the VA, a relatively equal access healthcare system, there is limited contribution of neighborhood-level socioeconomic deprivation to PDAC, except for patients with the highest neighborhood-level SES (lowest ADI).
Levinson et al. (Mon,) studied this question.