Introduction: The single-payer universal healthcare system in the province of Ontario creates a setting with reduced socioeconomic barriers to treatment. We sought to elucidate the influence of sociodemographic marginalization on receipt of adjuvant treatment and overall survival (OS) following resection of pancreatic adenocarcinoma (PC) at the population level. Method: Patients undergoing PC resection in Ontario between 2005 and 10 were identified using the provincial cancer registry, and linked to databases that include all treatments received and outcomes experienced. Pathology reports were abstracted for staging and margin status. Each patient's postal code was used to predict their median income, residential instability, material deprivation, ethnic concentration, and dependency (proportion of population aged <15, >65, or unemployed) using census data. Independent predictors of receipt of adjuvant treatment and OS were identified by logistic regression and Cox proportional hazards analysis. Results: 469 patients met inclusion criteria. Multivariable analysis did not identify a significant association between receipt of adjuvant treatment and residential instability (OR = 0.88, 95%CI = 0.69e1.14), material deprivation (OR = 0.95, 95%CI = 0.70e1.28), ethnic concentration (OR = 0.98, 95%CI = 0.78e1.22), or dependency (OR = 1.20, 95%CI = 0.94e1.52). Similarly, a significant association was not identified between survival and residential instability (HR = 1.00, 95%CI = 0.90e1.13), material deprivation (HR = 0.95, 95%CI = 0.84e1.08), ethnic concentration (HR = 1.05, 95%CI = 0.95e1.15), or dependency (HR = 0.94, 95%CI = 0.85e1.03). Compared to patients in the highest income quintile, patients in the second-highest demonstrated improved OS (HR = 0.63, 95%CI = 0.44e0.90), but those in lower income quintiles did not. Conclusions: In contrast to reports generated in other healthcare systems, measures of sociodemographic marginalization were not associated with worse processes or outcomes of care in this analysis.
