Factors Associated With Pancreatectomy Among Australians With Pancreatic Cancer: A Population‐Based Study
Arrisonia C. Doubatty, Sitwat Ali, Mary Waterhouse, Judi Adams, Christopher Baggoley, Karen Canfell, Michael Caruana, Daniel G. Croagh, Benedict Devereaux, Paul Grogan, Susan J. Jordan, Milton Kirkwood, Andrew J. Metz, Joel Rhee, John A. Windsor, John Zalcberg, Rachel E. NealeABSTRACT
Background
Pancreatectomy offers a potential cure for pancreatic cancer but may not be accessible to all Australians. We aimed to explore sociodemographic, healthcare and patient factors associated with undergoing pancreatectomy.
Methods
This study used a nationally linked dataset from the Australian Institute of Health and Welfare, including people diagnosed with pancreatic cancer between July 2010 and December 2018 (excluding Western Australia and the Northern Territory). Pancreatectomy trends were analysed using Joinpoint regression, and associations with sociodemographic, clinical and healthcare factors were assessed using log‐binomial regression, with causal mediation analysis assessing the extent to which private specialist visits mediated each association.
Results
Among 22 739 individuals with pancreatic cancer (mean age 72.5 years; 51% male), 15% underwent pancreatectomy. Uptake increased over time, with an average six‐monthly increase of 1.36% (95% confidence interval [CI] = 0.63–2.11). After adjustment for age, sex and comorbidities, older age was strongly associated with lower pancreatectomy prevalence (80+ years vs. 60–69 years: prevalence ratio [PR] = 0.16; 95% CI = 0.14–0.19). Lower prevalence was observed in remote areas (PR = 0.59; 95% CI = 0.43–0.77) and the most disadvantaged socioeconomic group (PR = 0.75; 95% CI = 0.68–0.82). Conversely, private specialist visits (PR = 1.60; 95% CI = 1.50–1.72) and general practitioner (GP) visits were associated with higher prevalence. Private specialist visits explained 61% of the regional–metropolitan difference and 41% of the high–low GP visits difference, and counteracted the negative effect of comorbidities.
Conclusions
Undergoing pancreatectomy is associated with sociodemographic, clinical and healthcare factors. Understanding the reasons is crucial to improving equity.