The Impact of Digital Inequities on Esophageal Cancer Disparities in the US
Author:
Fei-Zhang David J.1ORCID, Edwards Evan R.1, Asthana Shravan1, Chelius Daniel C.2, Sheyn Anthony M.3, Rastatter Jeffrey C.4
Affiliation:
1. Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA 2. Department of Otolaryngology—Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163, USA 3. Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA 4. Department of Otolaryngology—Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 675 N Saint Clair, Chicago, IL 60611, USA
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.
Subject
Cancer Research,Oncology
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