Abstract 2248: Diminished survival in patients with pancreatic ductal adenocarcinoma is linked with residence in redlined neighborhoods

Abstract Redlining refers to the practice of classifying neighborhoods with racial minorities and low-income residents as “hazardous” for investors. This discriminatory practice by the Home Owners’ Loan Corporation (HOLC) has been shown to impact patient cancer incidence and outcomes in breast, lung, cervical, and colorectal cancers. In this study, we evaluate the impact of HOLC status on pancreatic ductal adenocarcinoma (PDAC) outcomes in Virginia. The Virginia Department of Health Cancer Registry was queried for adult patients diagnosed with pancreatic ductal adenocarcinoma from 2009-2018. The HOLC grade (A: best, B: still desirable, C: definitely declining, D: hazardous) of each patient’s address was determined using the University of Richmond Inequality map. Patient demographics, treatment, and survival data were compared by HOLC Grade via descriptive statistics, bivariate and multivariate analysis. 394 patients were identified (A: 24 (6.1%), B: 54 (13.7%), C: 198 (50.3%), D: 118 (29.9%)). There was no association between patient age, sex, insurance status, receipt of therapy, or smoking history and HOLC status. Patient race was significantly associated with HOLC status with more Black patients living in areas with worse HOLC grades compared to White patients (p<0.001). Survival analysis demonstrated that lack of surgery and chemotherapy (p<0.0001), metastatic disease (p<0.0001), and residential status in areas of HOLC grade D (p=0.012) were associated with worse survival. Based on Cox regression analysis, patients who lived in areas with HOLC grade B (adjusted HR 0.70; CI 0.49-0.98) and C (adjusted HR 0.74; CI 0.58-0.95) had improved survival compared to those living in areas with HOLC grade D. Additionally, age greater than 65, metastatic disease, and lack of treatment were associated with worse survival. Residence in a redlined neighborhoods can play a significant role in pancreatic ductal adenocarcinoma outcomes. Location in a “hazardous” area in Virginia is associated with worse survival in PDAC patients. Disparities in socioeconomics, housing, education, and food accessibility in these areas likely play a role in shaping these outcomes. Future studies are warranted to further investigate this disparity in care. Citation Format: Vignesh Vudatha, Devon Freudenberger, Christopher Liu, Leopoldo Fernandez, Jose Trevino. Diminished survival in patients with pancreatic ductal adenocarcinoma is linked with residence in redlined neighborhoods [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2248.