The Impact of Digital Inequities on Esophageal Cancer Disparities in the US

Abstract

Background: There is currently no comprehensive tool that quantifiably measures validated factors of modern technology access in the US for digital inequity impact on esophageal cancer care (EC). Objective: To assess the influence of digital inequities on esophageal cancer disparities while accounting for traditional social determinants. Methods: 15,656 EC patients from 2013–2017 in SEER were assessed for significant regression trends in long-term follow-up, survival, prognosis, and treatment with increasing overall digital inequity, as measured by the Digital Inequity Index (DII). The DII was calculated based on 17 census tract-level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure access or sociodemographic, ranked, and then averaged into a composite score. Results: With increasing overall digital inequity, significant decreases in the length of long-term follow-up (p < 0.001) and survival (p < 0.001) for EC patients were observed. EC patients showed decreased odds of receiving indicated surgical resection (OR 0.97, 95% CI 0.95–99) with increasing digital inequity. They also showed increased odds of advanced preliminary staging (OR 1.02, 95% CI 1.00–1.05) and decreased odds of receiving indicated chemotherapy (OR 0.97;95% CI 0.95–99). Conclusions: Digital inequities meaningfully contribute to detrimental trends in EC patient care in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national, sociodemographic trends of the impact of online access on informed care.

The associations of food environment with gastrointestinal cancer outcomes in the United States

“…With the advent of SDoH-based tools developed from the US Census, there have been increased efforts to understand the interaction of socioeconomic status, race/ethnicity, household composition, housing-transportation, as well as nontraditional factors of digital and internet accessibility on healthcare outcomes. [10][11][12] While relatively understudied, nutrition and food access may be a driving influence on the incidence, stage, treatment, as well as regionalization of patients with GIC. [13][14][15] To date, most data on nutrition and food access have included only a general, pan-oncologic investigation demonstrating disparities among obese-individuals across a wide range of patients.…”

“…Recently, investigations using large data have sought to examine national cohorts of patients relative to SDoH to assess how these determinants may impact GIC and other cancer outcomes. With the advent of SDoH‐based tools developed from the US Census, there have been increased efforts to understand the interaction of socioeconomic status, race/ethnicity, household composition, housing‐transportation, as well as nontraditional factors of digital and internet accessibility on healthcare outcomes 10–12 …”