We sought to determine how social determinants of health (SDoH) related to outcomes following gastrectomy for gastric cancer in the Midsouth.
Data was obtained regarding patients who underwent gastrectomy for gastric cancer within a large healthcare system in the Midsouth between 2005 and 2011. Descriptive statistics were calculated, and adjusted regression analyses were performed to determine whether SDoH such as income, education, insurance, and employment were associated with inpatient length of stay (LOS), discharge destination, and 30-day readmission.
Among 403 patients, 6.2% were uninsured, 4.7% had Medicaid, and 48.9% had Medicare. Twenty-four percent were unemployed, 70.7% resided in regions with a lower median household income, and 60.3% resided in regions of lower education level. The median LOS was 8 days. Compared to patients with LOS ≤ 8 days, a greater proportion of patients with a longer LOS had Medicare (55.3% vs. 43.7%; p<0.01) and lower regional income level (80.9% vs. 71.1%; p=0.03). Odds of having a longer LOS were lower among employed compared to unemployed patients (OR=0.51; 95% CI: 0.27-0.99). Compared to patients discharged home, a greater proportion of patients discharged elsewhere had Medicare (72.2% vs. 45.9%; p=0.03) and resided in regions of lower education level (88.6% vs. 61.8%; p<0.01). Patients living in regions of higher education level were 84% less likely to be discharged to a destination other than their home (OR=0.16; 95% CI: 0.04-0.56). There was no association between measured SDoH and likelihood of readmission.
Adjusted regression analyses identified SDoH that predicted gastric cancer outcomes that increase cost of care and length of recovery. These disparities should be addressed to improve health equity among gastric cancer patients. Further investigation is needed to determine the extent of these costs and their impact on long-term outcomes and survival.