1 Citation (Scopus)

Abstract

Purpose The objective of this study was to examine rural/urban differences in post-operative mortality for elderly dually eligible Veteran patients with pancreatic cancer treated by surgery with or without adjuvant therapy. Materials and Methods In this retrospective observational study, Medicare claims data were used to identify elderly dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy with or without adjuvant therapy. Hierarchical logistic regression models adjusted for age, rurality of residence, post-operative complication rate, length of stay, blood transfusion during admission, and co-morbidity were examined to assess differences in mortality between rural and urban Veteran patients. Results Among 4,686 dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy between 1997 and 2011, those who lived in a small rural town focused area had significantly higher odds of one-year mortality (Odds Ratio [OR] = 1.50; p < 0.01; Confidence Interval [CI]: 1.15–1.95), compared to those who lived in an urban focused area. Surgical or 90-day mortality was not significantly associated with the rurality of the Veterans' residence. Patients who were younger, had fewer comorbidities, and shorter length of stay had lower odds of dying at 90 days and one year. Conclusions Using a nationally representative database we found that rural and older patients had worse long-term post-operative outcomes than their urban and younger counterparts, while there were no rural/urban differences in early post-operative outcomes. The study adds to evidence pointing to disparities in the quality of care of Veterans based on place of residence.

Original languageEnglish (US)
Pages (from-to)284-288
Number of pages5
JournalJournal of Geriatric Oncology
Volume8
Issue number4
DOIs
StatePublished - Jul 2017

Fingerprint

Pancreatectomy
Veterans
Pancreatic Neoplasms
Mortality
Length of Stay
Logistic Models
Quality of Health Care
Medicare
Blood Transfusion
Observational Studies
Comorbidity
Retrospective Studies
Odds Ratio
Databases
Confidence Intervals
Morbidity
Therapeutics

Keywords

  • Dually eligible Veterans
  • Mortality
  • Pancreatectomy
  • Pancreatic cancer
  • Rural disparities

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

Cite this

Mortality following pancreatectomy for elderly rural veterans with pancreatic cancer. / Nayar, Preethy; Chandak, Aastha; Yu, Fang; Sayles, Harlan; Ganti, Apar Kishor P.

In: Journal of Geriatric Oncology, Vol. 8, No. 4, 07.2017, p. 284-288.

Research output: Contribution to journalArticle

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abstract = "Purpose The objective of this study was to examine rural/urban differences in post-operative mortality for elderly dually eligible Veteran patients with pancreatic cancer treated by surgery with or without adjuvant therapy. Materials and Methods In this retrospective observational study, Medicare claims data were used to identify elderly dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy with or without adjuvant therapy. Hierarchical logistic regression models adjusted for age, rurality of residence, post-operative complication rate, length of stay, blood transfusion during admission, and co-morbidity were examined to assess differences in mortality between rural and urban Veteran patients. Results Among 4,686 dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy between 1997 and 2011, those who lived in a small rural town focused area had significantly higher odds of one-year mortality (Odds Ratio [OR] = 1.50; p < 0.01; Confidence Interval [CI]: 1.15–1.95), compared to those who lived in an urban focused area. Surgical or 90-day mortality was not significantly associated with the rurality of the Veterans' residence. Patients who were younger, had fewer comorbidities, and shorter length of stay had lower odds of dying at 90 days and one year. Conclusions Using a nationally representative database we found that rural and older patients had worse long-term post-operative outcomes than their urban and younger counterparts, while there were no rural/urban differences in early post-operative outcomes. The study adds to evidence pointing to disparities in the quality of care of Veterans based on place of residence.",
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T1 - Mortality following pancreatectomy for elderly rural veterans with pancreatic cancer

AU - Nayar, Preethy

AU - Chandak, Aastha

AU - Yu, Fang

AU - Sayles, Harlan

AU - Ganti, Apar Kishor P

PY - 2017/7

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N2 - Purpose The objective of this study was to examine rural/urban differences in post-operative mortality for elderly dually eligible Veteran patients with pancreatic cancer treated by surgery with or without adjuvant therapy. Materials and Methods In this retrospective observational study, Medicare claims data were used to identify elderly dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy with or without adjuvant therapy. Hierarchical logistic regression models adjusted for age, rurality of residence, post-operative complication rate, length of stay, blood transfusion during admission, and co-morbidity were examined to assess differences in mortality between rural and urban Veteran patients. Results Among 4,686 dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy between 1997 and 2011, those who lived in a small rural town focused area had significantly higher odds of one-year mortality (Odds Ratio [OR] = 1.50; p < 0.01; Confidence Interval [CI]: 1.15–1.95), compared to those who lived in an urban focused area. Surgical or 90-day mortality was not significantly associated with the rurality of the Veterans' residence. Patients who were younger, had fewer comorbidities, and shorter length of stay had lower odds of dying at 90 days and one year. Conclusions Using a nationally representative database we found that rural and older patients had worse long-term post-operative outcomes than their urban and younger counterparts, while there were no rural/urban differences in early post-operative outcomes. The study adds to evidence pointing to disparities in the quality of care of Veterans based on place of residence.

AB - Purpose The objective of this study was to examine rural/urban differences in post-operative mortality for elderly dually eligible Veteran patients with pancreatic cancer treated by surgery with or without adjuvant therapy. Materials and Methods In this retrospective observational study, Medicare claims data were used to identify elderly dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy with or without adjuvant therapy. Hierarchical logistic regression models adjusted for age, rurality of residence, post-operative complication rate, length of stay, blood transfusion during admission, and co-morbidity were examined to assess differences in mortality between rural and urban Veteran patients. Results Among 4,686 dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy between 1997 and 2011, those who lived in a small rural town focused area had significantly higher odds of one-year mortality (Odds Ratio [OR] = 1.50; p < 0.01; Confidence Interval [CI]: 1.15–1.95), compared to those who lived in an urban focused area. Surgical or 90-day mortality was not significantly associated with the rurality of the Veterans' residence. Patients who were younger, had fewer comorbidities, and shorter length of stay had lower odds of dying at 90 days and one year. Conclusions Using a nationally representative database we found that rural and older patients had worse long-term post-operative outcomes than their urban and younger counterparts, while there were no rural/urban differences in early post-operative outcomes. The study adds to evidence pointing to disparities in the quality of care of Veterans based on place of residence.

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