Survival Disparities Across Sociodemographics in Esophageal Adenocarcinoma

Purpose: Survival in those with esophageal adenocarcinoma (EAC) remains persistently poor despite recent advancements in targeted adjuvant and neoadjuvant therapies. Limited data currently exists evaluating these trends through the lens of sociodemographic disparities. We aim to quantify such data to further understand how EAC affects patients of diverse backgrounds.

Methods: We utilized the National Cancer Database (NCDB) from 2006-2019 to capture cases of EAC with complete demographic, socioeconomic, and survival data. We identified those with non-metastatic esophageal adenocarcinoma that underwent neoadjuvant chemoradiotherapy with subsequent esophagectomy. Multivariate regression analyses were applied to evaluate the impact of these factors on overall and four-year survival.

Results: 59,782 cases of EAC were included in the analysis. The patient population had a mean age of 64.3 years (SD 10.3), 81.8% were male and 92.5% were White, while 97% were non-Hispanic. On multivariate analysis, female sex (HR 0.888, 95% CI 0.86-0.92, p< 0.001) and Hispanic ethnicity (HR 0.878, 95% CI 0.81-0.95, p< 0.001) demonstrated improved overall and four-year survival. Black patients (HR 1.174, 95% CI 1.11-1.24, p< 0.001) and those on government insurance (HR 1.086, 95% CI 1.06-1.12, p< 0.001) or without insurance (HR 1.494, 95% CI 1.37-1.63) had an increased hazard of death. Using zip code as a surrogate, having not completed a high-school education (HR 1.071, 95% CI 1.02-1.12, p< 0.001) and having a lower median income ( <$42,227/year) (HR 1.143, 95% CI 1.09-1.20, p< 0.001) were also associated with decreased survival.

Conclusion: Several sociodemographic factors impact survival in EAC. Those identifying as female or Hispanic demonstrate improved survival. Blacks, those on government or without insurance, or those residing in areas with lower education or median income demonstrate worse survival. Abundant conversation regarding these disparities and action to mitigate such trends is essential.

Identify the source of the funding for this research project: No funding was provided.