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

Abstract

Abstract Objectives: To develop and implement a novel, comprehensive tool called the Digital Inequity Index (DII) that quantifiably measures modern technology access in the US and to assess the impact of digital inequity on esophageal cancer (EC) care nationwide. Methods: A total of15,656 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 DII. The DII was calculated based on 17 censustract-level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e.,education, income, disability status), 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 receivingthe indicated surgical resection (OR 0.90, 95% CI 0.84-96; OR 0.97; 95% CI0.95-1.00, respectively) 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 the 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. Level of Evidence: III