社会健康决定因素（SDoH）可能会影响医疗保健的获得。我们旨在评估在晚期消化道癌症患者中持续贫困（PP）、种族/民族和阿片类药物使用之间的关联。我们识别了2008年至2016年之间晚期消化道癌症（定义为临近死亡或入住临终关怀前30天）的SEER-Medicare患者，将数据与美国社区调查和农业部（2000-2015年）提供的县级贫困数据进行关联。我们将县分为从未高贫困（NHP）、间断高贫困（IHP）和持续贫困（PP）三类。我们研究了阿片类药物处方配药趋势和每日剂量（以吗啡毫克当量每天计算）。 在48,631名医疗保险受益人中（肝脏：n = 6551，13.5％；胰腺：n = 13,559，27.9％；胃：n = 5486，1.3％；结肠和直肠：n = 23,035，47.4％），在临近临终阶段，阿片类药物处方逐渐减少。黑人、亚洲人、西班牙裔和其他种族群体在临终阶段获得阿片类药物处方的几率显著降低（黑人：OR 0.84，95％CI 0.79-0.90；亚洲人：OR 0.86，95％CI 0.79-0.94；西班牙裔：OR 0.90，95％CI 0.84-0.95；其他：OR 0.83，95％CI 0.74-0.93；所有p <0.05）。就算在获得阿片类药物处方后，与白人患者相比，这部分患者的每日剂量较低（黑人：-16.5个百分点，95％CI -21.2到-11.6；亚洲人：-11.9个百分点，95％CI -18.5到-4.9；西班牙裔：-19.1个百分点，95％CI -23.5到-14.6；所有p <0.05）。在IHP / PP地区，亚洲人、西班牙裔和其他种族群体的阿片类药物获得和平均每日剂量的差距有所减轻，但在黑人患者中却加剧了。 基于种族/民族的晚期阶段疼痛管理不平等与基于SDoH的晚期阶段阿片类药物使用变异存在。特别是，PP影响了晚期阶段的阿片类药物获得和使用。 ©2023。外科肿瘤学学会。

Social determinants of health (SDoH) can impact access to healthcare. We sought to assess the association between persistent poverty (PP), race/ethnicity, and opioid access among patients with gastrointestinal cancer near the end-of-life (EOL).SEER-Medicare patients with gastric, liver, pancreatic, biliary, colon, and rectal cancer were identified between 2008 and 2016 near EOL, defined as 30 days before death or hospice enrolment. Data were linked with county-level poverty from the American Community Survey and the US Department of Agriculture (2000-2015). Counties were categorized as never high-poverty (NHP), intermittent high-poverty (IHP) and persistent poverty (PP). Trends in opioid prescription fills and daily dosages (morphine milligram equivalents per day) were examined.Among 48,631 Medicare beneficiaries (liver: n = 6551, 13.5%; pancreas: n = 13,559, 27.9%; gastric: n = 5486, 1.3%; colorectal: n = 23,035, 47.4%), there was a steady decrease in opioid prescriptions near EOL. Black, Asian, Hispanic, and other racial groups had markedly decreased odds of filling an opioid prescription near EOL (Black: OR 0.84, 95% CI 0.79-0.90; Asian: OR 0.86, 95% CI 0.79-0.94; Hispanic: OR 0.90, 95% CI 0.84-0.95; Other: OR 0.83, 95% CI 0.74-0.93; all p < 0.05). Even after filling an opioid prescription, this subset of patients received lower daily doses versus White patients (Black: -16.5 percentage points, 95% CI -21.2 to -11.6; Asian: -11.9 percentage points, 95% CI -18.5 to -4.9; Hispanic: -19.1 percentage points, 95%CI -23.5 to -14.6; all p < 0.05). The disparity in opioid access and average daily doses among was attenuated in IHP/PP areas for Asian, Hispanic, and other racial groups, yet exacerbated among Black patients.Race/ethnicity-based disparities in EOL pain management persist with SDoH-based variations in EOL opioid use. In particular, PP impacted EOL opioid access and utilization.© 2023. Society of Surgical Oncology.