Impact of Socioeconomic Factors on Survival in Locoregional Gastroesophageal Junction Cancer: A SEER‐Based Analysis
Susana Fortich, Caroline Baughn, Suzanne Klimberg, Roman Petrov, Raj G. VaghjianiABSTRACT
Background
Gastroesophageal junction cancer is a rising global health concern with variable outcomes. The availability to high‐volume cancer centers may influence survival, yet disparities related to geography and socioeconomic status remain poorly defined.
Methods
A retrospective cohort study was conducted using the SEER 21 Research Plus database (2000–2022). A total of 40,273 patients with locoregional gastroesophageal junction cancer were included. Patient‐level variables included age, sex, race, histology, stage, and survival. Socioeconomic and geographic variables included county‐level median household income and rural–urban residence. State‐level volume was defined according to the number of high‐volume esophageal cancer centers within each patient's state of residence: high‐volume (≥ 2 centers), moderate‐volume (1 center), and low‐volume (no centers). The primary outcome was overall survival. Cox proportional hazards models were used to evaluate associations between patient‐, socioeconomic‐, geographic‐, and state‐level factors and survival.
Results
Residence in states with lower‐volume centers was associated with worse outcomes than residence in states with high‐volume centers. Each step toward lower‐volume categories was associated with an increased hazard of death (HR 0.923, 95% CI 0.899–0.949, p < 0.001). While stage at diagnosis varied significantly across hospital volume categories ( p < 0.001), no clear pattern of more advanced stage in lower‐volume states was observed. Patients with adenocarcinoma had a 25% lower hazard of death compared to those with squamous cell carcinoma (HR 0.752, 95% CI 0.726–0.780, p < 0.001). Female gender was associated with a statistically significant increase in hazard of death compared to males (HR 1.042, 95% CI 1.013–1.072, p = 0.004). Additionally, higher median household income was associated with improved survival (HR 1.006, p < 0.001 per category increase), and urban residence (HR 1.036, p < 0.001) was independently associated with improved survival.
Conclusions
Survival in locoregional gastroesophageal junction cancer is influenced by both tumor biology and healthcare access. Residence in states with high‐volume centers, adenocarcinoma histology, higher income, and urban residence were independently associated with improved survival, highlighting disparities tied to regional resource availability within the United States.