Association of County-level Social Determinants and Pancreatic Cancer Incidence in the United States

Kenneth Luberice; Michael C Cantrell; Lauren Edgar; Carmen Smotherman; Christina Guerrier; Ramzi G Salloum; Alexander S Parker; Erin M Mobley; Ziad T Awad

doi:10.21873/anticanres.17622

Association of County-level Social Determinants and Pancreatic Cancer Incidence in the United States

Anticancer Res. 2025 Jun;45(6):2507-2514. doi: 10.21873/anticanres.17622.

Authors

Affiliations

¹ Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL, U.S.A.
² Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, U.S.A.
³ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, U.S.A.
⁴ Office of Research Affairs, College of Medicine, University of Florida, Jacksonville, FL, U.S.A.
⁵ Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL, U.S.A.; Ziad.Awad@jax.ufl.edu.

^# Contributed equally.

PMID: 40425322
DOI: 10.21873/anticanres.17622

Abstract

Background/aim: Pancreatic cancer remains a major cause of cancer-related deaths worldwide, with incidence rising and significantly influenced by social determinants of health (SDOH). While national data have explored these risk factors, county-level data offer unique insight into localized disparities. This study examines the association between county-level SDOH and pancreatic cancer incidence using backward variable selection to address multicollinearity and identify actionable intervention points.

Patients and methods: Age-adjusted pancreatic cancer incidence data (2012-2016) were obtained from the SEER database. County-level SDOH data were extracted from the American Community Survey, USDA Economic Research Service, County Health Rankings, US Diabetes Surveillance System, and US Renal Data System. Counties were grouped based on incidence rates above or below the national average (10.34/100,000). Logistic regression with backward selection estimated odds of high pancreatic cancer incidence, with significance set at p<0.05. Analyses were conducted using SAS^® 9.4.

Results: Several factors were initially associated with high pancreatic cancer incidence, including greater proportions of Black residents, physical inactivity, diabetes, obesity, smoking, lack of insurance, food desert residence, low vehicle availability, and lower median income. However, after backward selection, the only significant factor remaining was smoking prevalence. Counties in the 3^rd and 4^th quartiles of smoking had significantly higher odds of pancreatic cancer incidence compared to those in the 1st quartile [odds ratio (OR)=5.4; 95% confidence interval (CI)=2.0-14.1] and OR=4.3; 95%CI=1.7-11.2, respectively].

Conclusion: High county-level smoking prevalence is the most significant SDOH associated with elevated pancreatic cancer incidence. Public health interventions targeting smoking cessation, particularly in socioeconomically disadvantaged regions, may significantly reduce the pancreatic cancer burden.

Keywords: Pancreatic cancer; cancer incidence; social determinants of health; tobacco cessation.

MeSH terms

Aged
Female
Humans
Incidence
Male
Middle Aged
Pancreatic Neoplasms* / epidemiology
Risk Factors
SEER Program
Social Determinants of Health* / statistics & numerical data
Socioeconomic Factors
United States / epidemiology