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

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...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2023-09, Vol.27 (9), p.1883-1892
Main Authors: Shaikh, Chanza F., Woldesenbet, Selamawit, Munir, Muhammad Musaab, Moazzam, Zorays, Endo, Yutaka, Alaimo, Laura, Azap, Lovette, Yang, Jason, Katayama, Erryk, Lima, Henrique A., Dawood, Zaiba, Pawlik, Timothy M.
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
Aged
Beneficiaries
Comorbidity
Environmental conditions
Environmental factors
Environmental protection
Environmental quality
Female
Gastroenterology
Gastrointestinal surgery
Government programs
Health care access
Health care policy
Health maintenance organizations
HMOs
Humans
Male
Medicare
Medicine
Medicine & Public Health
Minority & ethnic groups
Mortality
Oncology
Original Article
Pancreatic cancer
Pancreatic Neoplasms - surgery
Patients
Race
Sociodemographics
Surgery
United States
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Summary: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   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  
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-023-05757-y