{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:26:21Z","timestamp":1777670781854,"version":"3.51.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"2","funder":[{"name":"Yale School of Medicine Leon Rosenberg, M.D. Medical Student Research Fund in Genetics"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Individual-level social determinants of health are associated with pancreatic ductal adenocarcinoma; however, it is currently unknown whether neighborhood-level socioeconomic disadvantage is related to the risk of pancreatic ductal adenocarcinoma diagnosis. Area deprivation index is a validated tool to measure neighborhood-level disadvantage. We conducted a retrospective cohort study of 5\u2009069\u2009429 patients in the Veterans Health Administration between October 1, 2001, and December 31, 2021. Area deprivation index percentiles were grouped using national area deprivation index decile cutoffs. In multivariable analysis, the lowest area deprivation index group, representing the highest neighborhood-level socioeconomic status, was associated with increased hazards for pancreatic ductal adenocarcinoma (adjusted hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.06 to 1.21) compared with those with median area deprivation index percentiles. Differences in pancreatic ductal adenocarcinoma hazards were not seen in the other area deprivation index percentiles. These results suggest that within the Veterans Health Administration, a relatively equal access health-care system, there is limited contribution of neighborhood-level socioeconomic deprivation to pancreatic ductal adenocarcinoma, except for patients with the highest neighborhood-level socioeconomic status (lowest area deprivation index).<\/jats:p>","DOI":"10.1093\/jncics\/pkag012","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T12:25:19Z","timestamp":1770035119000},"source":"Crossref","is-referenced-by-count":0,"title":["Neighborhood-level socioeconomic disadvantage and pancreatic cancer among veterans"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9108-1234","authenticated-orcid":false,"given":"Rachel N","family":"Levinson","sequence":"first","affiliation":[{"name":"Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Medicine, VA Connecticut Healthcare System , West Haven, CT,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9278-2000","authenticated-orcid":false,"given":"Ryan","family":"Bushman","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Medicine, VA Connecticut Healthcare System , West Haven, CT,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Mezzacappa","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet P","family":"Tate","sequence":"additional","affiliation":[{"name":"Department of Medicine, VA Connecticut Healthcare System , West Haven, CT,","place":["United States"]},{"name":"Section of General Medicine, Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0139-5502","authenticated-orcid":false,"given":"Amy C","family":"Justice","sequence":"additional","affiliation":[{"name":"Department of Medicine, VA Connecticut Healthcare System , West Haven, CT,","place":["United States"]},{"name":"Section of General Medicine, Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"School of Public Health, Yale University , New Haven, CT,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9261-8371","authenticated-orcid":false,"given":"Louise L","family":"Wang","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Medicine, VA Connecticut Healthcare System , West Haven, CT,","place":["United States"]},{"name":"Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"2026042903564453200_pkag012-B1","author":"Surveillance Research Program, National Cancer Institute","year":"2023"},{"key":"2026042903564453200_pkag012-B2","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1200\/JCO.2022.40.4_suppl.520","article-title":"Race, sex, age, and geographic disparities in pancreatic cancer incidence","volume":"40","author":"Moshayedi","year":"2022","journal-title":"J Clin Oncol"},{"key":"2026042903564453200_pkag012-B3","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.cgh.2019.05.059","article-title":"Racial disparities and trends in pancreatic cancer incidence and mortality in the United States","volume":"18","author":"Tavakkoli","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026042903564453200_pkag012-B4","author":"SEER*Explorer Application","year":"2025"},{"key":"2026042903564453200_pkag012-B5","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1093\/ije\/dyx232","article-title":"Pancreatic cancer incidence trends: evidence from the Surveillance, Epidemiology and End Results (SEER) population-based data","volume":"47","author":"Gordon-Dseagu","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2026042903564453200_pkag012-B6","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1002\/cncr.20771","article-title":"Risk of pancreatic adenocarcinoma","volume":"103","author":"Chang","year":"2005","journal-title":"Cancer"},{"key":"2026042903564453200_pkag012-B7","doi-asserted-by":"publisher","first-page":"e3639","DOI":"10.1371\/journal.pone.0003639","article-title":"Education and risk of cancer in a large cohort of men and women in the United States","volume":"3","author":"Mouw","year":"2008","journal-title":"PLoS One"},{"key":"2026042903564453200_pkag012-B8","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1158\/1055-9965.EPI-18-1153","article-title":"Socioeconomic effect of education on pancreatic cancer risk in western Europe: an update on the EPIC Cohorts Study","volume":"28","author":"Cirera","year":"2019","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2026042903564453200_pkag012-B9","doi-asserted-by":"publisher","first-page":"e2139593","DOI":"10.1001\/jamanetworkopen.2021.39593","article-title":"Neighborhood and individual socioeconomic disadvantage and survival among patients with nonmetastatic common cancers","volume":"4","author":"Cheng","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026042903564453200_pkag012-B10","author":"Neighborhood Poverty: All neighborhoods should be communities of opportunity. National Equity Atlas","year":"2024"},{"key":"2026042903564453200_pkag012-B11","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible\u2013the neighborhood atlas","volume":"378","author":"Kind","year":"2018","journal-title":"N Engl J Med"},{"key":"2026042903564453200_pkag012-B12","doi-asserted-by":"publisher","first-page":"pkaa011","DOI":"10.1093\/jncics\/pkaa011","article-title":"Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state","volume":"4","author":"Fairfield","year":"2020","journal-title":"JNCI Cancer Spectrum"},{"key":"2026042903564453200_pkag012-B13","doi-asserted-by":"publisher","first-page":"14623","DOI":"10.1002\/cam4.6065","article-title":"The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit","volume":"12","author":"Purrington","year":"2023","journal-title":"Cancer Med"},{"key":"2026042903564453200_pkag012-B14","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/S1386-5056(02)00131-4","article-title":"VistA\u2014U.S. Department of Veterans Affairs national-scale HIS","volume":"69","author":"Brown","year":"2003","journal-title":"Int J Med Inform"},{"key":"2026042903564453200_pkag012-B15","doi-asserted-by":"publisher","first-page":"469","DOI":"10.7205\/MILMED-D-15-00094","article-title":"Veterans affairs health system enrollment and health care utilization after the Affordable Care Act: initial insights","volume":"181","author":"Silva","year":"2016","journal-title":"Military Med"},{"key":"2026042903564453200_pkag012-B16","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1007\/s11606-008-0521-4","article-title":"Racial and ethnic disparities in the VA health care system: a systematic review","volume":"23","author":"Saha","year":"2008","journal-title":"J Gen Intern Med"},{"key":"2026042903564453200_pkag012-B17","volume-title":"National Healthcare Quality and Disparities Report: chartbook on Healthcare for Veterans","year":"2020"},{"key":"2026042903564453200_pkag012-B18","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2026042903564453200_pkag012-B19","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1007\/s11606-023-08125-3","article-title":"Travel burden as a measure of healthcare access and the impact of telehealth within the Veterans Health Administration","volume":"38","author":"Hahn","year":"2023","journal-title":"J Gen Intern Med"},{"key":"2026042903564453200_pkag012-B20","year":"2024"},{"key":"2026042903564453200_pkag012-B21","doi-asserted-by":"publisher","first-page":"2208","DOI":"10.1056\/NEJMp1615069","article-title":"Income and cancer overdiagnosis\u2013when too much care is harmful","volume":"376","author":"Welch","year":"2017","journal-title":"New Eng J Med"},{"key":"2026042903564453200_pkag012-B22","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1007\/s11606-023-08208-1","article-title":"A decade of focus on and improvement in access to care in the Veterans Health Administration","volume":"38","author":"Kaboli","year":"2023","journal-title":"J Gen Intern Med"},{"key":"2026042903564453200_pkag012-B23","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.21037\/jgo-21-788","article-title":"Association of social determinants of health with late diagnosis and survival of patients with pancreatic cancer","volume":"13","author":"Fabregas","year":"2022","journal-title":"J Gastrointest Oncol"},{"key":"2026042903564453200_pkag012-B24","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/SLA.0000000000005712","article-title":"Neighborhood deprivation, hospital quality, and mortality after cancer surgery","volume":"277","author":"Bonner","year":"2023","journal-title":"Ann Surg"},{"key":"2026042903564453200_pkag012-B25","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1093\/jnci\/djad102","article-title":"Association of rurality, socioeconomic status, and race with pancreatic cancer surgical treatment and survival","volume":"115","author":"Brooks","year":"2023","journal-title":"JNCI: J Natl Cancer Inst"},{"key":"2026042903564453200_pkag012-B26","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1002\/jso.27996","article-title":"Evaluating the Association of Area Deprivation Index (ADI) on postoperative outcomes in pancreatic adenocarcinoma","volume":"131","author":"Khalid","year":"2025","journal-title":"J Surg Oncol"},{"key":"2026042903564453200_pkag012-B27","doi-asserted-by":"publisher","first-page":"108804","DOI":"10.1016\/j.surg.2024.07.059","article-title":"Redefining at-risk patients undergoing pancreaticoduodenectomy: impact of socioeconomic factors including Area Deprivation Index and distance traveled","volume":"179","author":"Lim","year":"2025","journal-title":"Surgery"},{"key":"2026042903564453200_pkag012-B28","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1245\/s10434-023-14347-w","article-title":"Association of neighborhood disadvantage with short- and long-term outcomes after pancreatectomy for pancreatic ductal adenocarcinoma","volume":"31","author":"Marcinak","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"2026042903564453200_pkag012-B29","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.amjsurg.2020.12.001","article-title":"Adjuvant therapy rates and overall survival in patients with localized pancreatic cancer from high Area Deprivation Index neighborhoods","volume":"222","author":"Mora","year":"2021","journal-title":"Am J Surg"},{"key":"2026042903564453200_pkag012-B30","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/j.amjsurg.2023.06.013","article-title":"Implications of the interaction between travel burden and area deprivation for patients with pancreatic cancer","volume":"226","author":"Murimwa","year":"2023","journal-title":"Am J Surg"},{"key":"2026042903564453200_pkag012-B31","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1016\/j.hpb.2023.08.005","article-title":"Area deprivation and rurality impact overall survival and adjuvant therapy administration in patients with pancreatic ductal adenocarcinoma (PDAC)","volume":"25","author":"Pothuri","year":"2023","journal-title":"HPB"},{"key":"2026042903564453200_pkag012-B32","doi-asserted-by":"publisher","first-page":"e564","DOI":"10.1097\/SLA.0000000000003706","article-title":"The impact of socioeconomic deprivation on clinical outcomes for pancreatic adenocarcinoma at a high-volume cancer center: a retrospective cohort analysis","volume":"274","author":"Powers","year":"2021","journal-title":"Ann Surg"},{"key":"2026042903564453200_pkag012-B33","doi-asserted-by":"publisher","first-page":"3194","DOI":"10.1245\/s10434-021-11250-0","article-title":"Socioeconomic disparities in pancreas cancer resection and survival in the Veterans Health Administration","volume":"29","author":"Del Valle","year":"2022","journal-title":"Ann Surg Oncol"},{"key":"2026042903564453200_pkag012-B34","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1158\/1055-9965.EPI-16-0941","article-title":"Contextual impact of neighborhood obesogenic factors on postmenopausal breast cancer: the Multiethnic Cohort","volume":"26","author":"Conroy","year":"2017","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2026042903564453200_pkag012-B35","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1158\/1055-9965.EPI-10-0021","article-title":"Breast cancer incidence patterns among California Hispanic women: differences by nativity and residence in an enclave","volume":"19","author":"Keegan","year":"2010","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2026042903564453200_pkag012-B36","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1089\/thy.2012.0392","article-title":"Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the Surveillance, Epidemiology, and End Results registry, 1980\u20132008","volume":"23","author":"Li","year":"2013","journal-title":"Thyroid"},{"key":"2026042903564453200_pkag012-B37","doi-asserted-by":"publisher","first-page":"2282","DOI":"10.1016\/j.jid.2017.06.024","article-title":"Continued increase in melanoma incidence across all socioeconomic status groups in California, 1998\u20132012","volume":"137","author":"Clarke","year":"2017","journal-title":"Journal of Investigative Dermatology"},{"key":"2026042903564453200_pkag012-B38","doi-asserted-by":"publisher","first-page":"2567","DOI":"10.21037\/jgo-20-583","article-title":"Social determinants of health associated with poor outcome for rural patients following resected pancreatic cancer","volume":"12","author":"Chu","year":"2021","journal-title":"J Gastrointest Oncol"},{"key":"2026042903564453200_pkag012-B39","doi-asserted-by":"publisher","first-page":"5070","DOI":"10.3390\/cancers15205070","article-title":"Pancreatic cancer health disparity: pharmacologic anthropology","volume":"15","author":"Wall","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2026042903564453200_pkag012-B40","year":"2008"}],"container-title":["JNCI Cancer Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jncics\/advance-article-pdf\/doi\/10.1093\/jncics\/pkag012\/66790274\/pkag012.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jncics\/article-pdf\/10\/2\/pkag012\/66790274\/pkag012.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jncics\/article-pdf\/10\/2\/pkag012\/66790274\/pkag012.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:57:58Z","timestamp":1777449478000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jncics\/article\/doi\/10.1093\/jncics\/pkag012\/8465576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jncics\/pkag012","relation":{},"ISSN":["2515-5091"],"issn-type":[{"value":"2515-5091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,2,5]]},"article-number":"pkag012"}}