{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:10:58Z","timestamp":1777864258780,"version":"3.51.4"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cholangiocarcinoma (CCA) carries a dismal prognosis. Beyond clinical determinants, socioeconomic deprivation may also influence outcomes. Busan, a rapidly aging metropolitan area in Korea, provides a critical setting for evaluating how area-level deprivation interacts with individual risk factors for CCA survival. However, evidence regarding the effect of area-level deprivation on CCA survival remains scarce, particularly within the Korean population. We aimed to evaluate the association between the deprivation index (DI) and individual clinical factors and provide a deeper understanding of the variability in the survival rates of patients with CCA in Busan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 12,950 patients diagnosed with CCA between 2003 and 2020 using the Busan Regional Cancer Registry linked with national death records. Individual-level variables included age, sex, stage, and year of diagnosis, while area-level deprivation was quantified using the census-derived DI. Multilevel survival analyses were performed using a frailty Cox proportional hazards model with a random intercept for region to estimate hazard ratios (HRs) for both individual- and regional-level predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median survival period was 42\u202fweeks. Survival declined with age (46.5% vs. 21.3% in patients aged 0\u201344\u202fyears and \u226575\u202fyears, respectively,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and was significantly lower in advanced-stage disease (47.7% localized vs. 8.07% distant,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Men had marginally higher survival rates than women (33.8% vs. 32.1%, p\u202f&amp;lt;\u202f0.001). Deprivation strongly influenced prognosis, as patients in the most deprived areas had a 30.1% survival rate compared with 36.3% in the least deprived areas (p\u202f&amp;lt;\u202f0.001). In fully adjusted models, age \u226575\u202fyears (HR 2.68), regional (HR 1.40) and distant stages (HR 3.77), and higher DI (HR 1.06 per unit) independently predicted poorer survival. Incorporating DI into the models slightly reduced the between-region variance (\n                      <jats:italic>\u03c3<\/jats:italic>\n                      ) and median hazard ratio (MHR), indicating that area-level deprivation partially explains regional differences in survival outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CCA survival in Busan is influenced by both individual vulnerability and area-level deprivation. Older age, advanced stage, and higher deprivation were identified as independent poor prognostic factors for CCA survival. In super-aged urban societies, integrating social determinants into clinical care is essential to reduce inequities and improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1771770","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:39:05Z","timestamp":1777527545000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of small area-level deprivation on survival outcomes in patients with Cholangiocarcinoma: a population-based multilevel survival analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Jonghyun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Division of Gastroenterology, Department of Internal Medicine and Biomedical Research Institute, Busan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahreum","family":"Kim","sequence":"additional","affiliation":[{"name":"Office of Public Healthcare Service, Pusan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seunghye","family":"Jang","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute, Pusan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changhoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Uk","family":"Kim","sequence":"additional","affiliation":[{"name":"Gumi Medical Center, Department of Internal Medicine, CHA University","place":["Gumi, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung Yong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Division of Gastroenterology, Department of Internal Medicine and Biomedical Research Institute, Busan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Department of Family Medicine and Biomedical Research Institute, Pusan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Hyeon","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Department of Family Medicine and Biomedical Research Institute, Pusan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heeseung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Department of Surgery and Biomedical Research Institute, Pusan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoun","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Division of Gastroenterology, Department of Internal Medicine and Biomedical Research Institute, Busan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung Min","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]},{"name":"Division of Gastroenterology, Department of Internal Medicine and Biomedical Research Institute, Busan National University Hospital","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun Joo","family":"Lee","sequence":"additional","affiliation":[{"name":"Biomedical Research Institute, Pusan National University Hospital","place":["Busan, Republic of Korea"]},{"name":"Department of Obstetrics and Gynecology, School of Medicine, Pusan National University","place":["Busan, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1116338","DOI":"10.3389\/fonc.2023.1116338","article-title":"Adjuvant therapy for Cholangiocarcinoma after surgery and prognosis factors for Cholangiocarcinoma: a single-center retrospective cohort study","volume":"13","author":"Sun","year":"2023","journal-title":"Front Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12957-024-03327-3","article-title":"Survival analysis of laparoscopic surgery and open surgery for hilar Cholangiocarcinoma: a retrospective cohort study","volume":"22","author":"Yin","year":"2024","journal-title":"World J Surg Oncol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1159\/000018654","article-title":"Clinical presentation, diagnosis and survival of resected distal bile duct 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