Racial Disparities in Pancreatic Cancer

Objectives: Racial disparities in pancreatic cancer outcomes remain incompletely explained. Using a large population-based data set, we quantified racial differences in survival and evaluated mediators, including surgical access, treatment timeliness, and area-level socioeconomic status. Methods: We conducted a retrospective cohort study using SEER data. Adults with malignant pancreatic neoplasms were included; patients with unknown race or missing survival data were excluded. Race was classified as White, Black, or Other. Coprimary outcomes were overall survival (OS) and cancer-specific survival (CSS). Analyses included Kaplan-Meier survival analysis, multivariable Cox regression, and propensity-score matching. Results: The cohort comprised 162,783 patients: White 130,374 (80.1%), Black 18,858 (11.6%), and Other 13,551 (8.3%). Median OS was 6, 5, and 6 months; 5-year OS was 8.8%, 8.2%, and 10.7%, respectively ( P <0.001). The Black race was associated with worse OS (HR 1.097; 95% CI: 1.079-1.115) and CSS (HR 1.064; 95% CI: 1.046-1.083) versus White. After matching (18,858 pairs), the Black race remained associated with worse OS (HR 1.158; 95% CI: 1.131-1.185) and CSS (HR 1.121; 95% CI: 1.094-1.148). Black patients had lower surgical receipt (13.9% vs. 16.6%), lower adjusted odds of surgery (OR 0.717; 95% CI: 0.684-0.752), and longer time-to treatment (37.0 vs. 33.2 d). Surgery explained 26.3% of the disparity, and income explained 14.2%; 56.1% remained unexplained. Conclusions: Black patients with pancreatic cancer had worse OS and CSS than White patients, only partly explained by lower surgical receipt and socioeconomic differences.