Understanding Disparities in Receipt of Complex Gastrointestinal Cancer Surgery at a Small Geographic Scale

Area of Science:

• Oncology
• Health Services Research
• Geographic Information Systems

Background:

• Geographic variations in complex cancer surgery receipt are not well understood, particularly at a granular neighborhood level.
• Complex gastrointestinal (GI) cancers present unique challenges for surgical treatment access.

Purpose of the Study:

• To define neighborhood-level disparities in the receipt of complex cancer surgery.
• To identify geographic clusters of high and low surgery rates for complex GI cancers.

Main Methods:

• Utilized data from the Ohio Cancer Incidence Surveillance System (2009-2018) for 5 complex GI cancers.
• Employed the Max-p-regions method to create "MaxTracts" preserving privacy while enabling small-area analysis.
• Applied Hot Spot analysis to identify surgery rate clusters and compared neighborhood characteristics using US Census and CDC PLACES data.

Main Results:

• Analyzed 33,091 patients across 1006 MaxTracts; surgery rates varied widely (20.7% to 92.3%).
• Low-surgery clusters were concentrated in urban cores and Appalachia, while high-surgery clusters were predominantly in suburban areas.
• Low-surgery areas exhibited higher poverty (23% vs. 12%), fewer married households (40% vs. 50%), and increased tobacco use (25% vs. 19%) compared to high-surgery areas.

Conclusions:

• Understanding neighborhood variations in surgery receipt is crucial for developing targeted interventions to reduce cancer treatment disparities.
• The methodology can be adapted to analyze disparities in other cancer types and treatment phases.