社会经济地位往往决定了对及时手术治疗和术后结果的获取。我们旨在分析县级贫穷持续时间对肝胰胆癌结果的影响。从1980年至2010年的美国人口普查和农业部的县级贫穷数据中，通过监测、流行病学和终身医疗保险2010至2015年的数据库，确定了肝胰胆癌患者。县被归类为从未高贫穷、间歇性高贫穷和持续贫穷。使用分层广义线性模型和具有Weibull分布的加速失效时间模型评估了诊断、治疗、标准结果和生存。在41077位患者中，有1758人（4.3％）居住在持续贫困地区。长期贫困地区的人群中，非裔黑人患者的比例增加（从未高贫穷：7.6％，间歇性高贫穷：20.4％，持续贫穷：23.2％），无保险患者（从未高贫穷：0.5％，间歇性高贫穷：0.5％，持续贫穷：0.9％）和农村居民（从未高贫穷：0.6％，间歇性高贫穷：2.4％，持续贫穷：11.5％）的比例增加。居住在持续贫困地区的个体接受切除手术的可能性较低（OR为0.82，95％CI为0.66-0.98），实现标准结果的可能性较低（OR为0.54，95％CI为0.34-0.84）且癌症特异性死亡率增加（风险比为1.07，95％CI为1.00-1.15）（所有P <0.05）。与非裔白人患者相比，非裔黑人患者更不可能出现早期疾病（OR为0.86，95％CI为0.79-0.95）和接受手术治疗（OR为0.58，95％CI为0.52-0.66）（两者P <0.01）。值得注意的是，持续贫困地区的非裔白人患者更有可能出现早期疾病（OR为1.30，95％CI为1.12-1.52）并接受局部疾病手术治疗（OR为1.36，95％CI为1.06-1.74），而非裔黑人患者在从未高贫穷地区（两者P <0.05）。贫困时间与接受手术治疗、实现标准结果和恶性肿瘤特异性生存的可能性降低有关。非裔黑人患者特别容易出现次优的结果，突显出结构性种族主义独立于社会经济地位的影响。

Socioeconomic status can often dictate access to timely surgical care and postoperative outcomes. We sought to analyze the impact of county-level poverty duration on hepatopancreaticobiliary cancer outcomes.Patients diagnosed with hepatopancreaticobiliary cancer were identified from the Surveillance, Epidemiology, and End Results-Medicare 2010 to 2015 database linked with county-level poverty from the American Community Survey and the US Department of Agriculture between 1980 to 2010. Counties were categorized as never high-poverty, intermittent high-poverty, and persistent poverty. Hierarchical generalized linear models and accelerated failure time models with Weibull distribution were used to assess diagnosis, treatment, textbook outcomes, and survival.Among 41,077 patients, 1,758 (4.3%) lived in persistent poverty. Counties exposed to greater durations of poverty had increased proportions of non-Hispanic Black patients (never high-poverty: 7.6%, intermittent high-poverty: 20.4%, persistent poverty: 23.2%), uninsured patients (never high-poverty: 0.5%, intermittent high-poverty: 0.5%, persistent poverty: 0.9%), and patients with a rural residence (never high-poverty: 0.6%, intermittent high-poverty: 2.4%, persistent poverty: 11.5%). Individuals residing in persistent poverty had lower odds of undergoing resection (odds ratio 0.82, 95% confidence interval 0.66-0.98), achieving textbook outcomes (odds ratio 0.54, 95% confidence interval 0.34-0.84), and increased cancer-specific mortality (hazard ratio 1.07, 95% CI 1.00-1.15) (all P < .05). Non-Hispanic Black patients were less likely to present with early-stage disease (odds ratio 0.86, 95% confidence interval 0.79-0.95) and undergo surgical treatment (odds ratio 0.58, 95% confidence interval 0.52-0.66) compared to non-Hispanic White patients (both P < .01). Notably, non-Hispanic White patients in persistent poverty were more likely to present with early-stage disease (odds ratio 1.30, 95% confidence interval 1.12-1.52) and undergo surgery for localized disease (odds ratio 1.36, 95% confidence interval 1.06-1.74) compared to non-Hispanic Black patients in never high-poverty (both P < .05).Duration of poverty was associated with lower odds of receipt of surgical treatment, achievement of textbook outcomes, and worse cancer-specific survival. Non-Hispanic Black patients were at particular risk of suboptimal outcomes, highlighting the impact of structural racism independent of socioeconomic status.Copyright © 2023 Elsevier Inc. All rights reserved.