Background: There is currently no comprehensive tool that quantifiably measures validated factors of modern technology access in the US for digital inequity impact on esophageal cancer care (EC). Objective: To assess the influence of digital inequities on esophageal cancer disparities while accounting for traditional social determinants. Methods: 15,656 EC patients from 2013–2017 in SEER were assessed for significant regression trends in long-term follow-up, survival, prognosis, and treatment with increasing overall digital inequity, as measured by the Digital Inequity Index (DII). The DII was calculated based on 17 census tract-level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure access or sociodemographic, ranked, and then averaged into a composite score. Results: With increasing overall digital inequity, significant decreases in the length of long-term follow-up (p< 0.001) and survival (p< 0.001) for EC patients were observed. EC patients showed decreased odds of receiving indicated surgical resection (OR 0.97, 95% CI 0.95–99) with increasing digital inequity. They also showed increased odds of advanced preliminary staging (OR 1.02, 95% CI 1.00–1.05) and decreased odds of receiving indicated chemotherapy (OR 0.97;95% CI 0.95–99). Conclusions: Digital inequities meaningfully contribute to detrimental trends in EC patient care in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national, sociodemographic trends of the impact of online access on informed care.
背景：目前美国尚无综合性工具能够量化评估现代技术获取的有效因素对食管癌（EC）诊疗中数字不平等的影响。目的：在控制传统社会决定因素的基础上，评估数字不平等对食管癌诊疗差异的影响。方法：基于监测、流行病学和最终结果数据库（SEER）2013-2017年15,656例食管癌患者数据，采用数字不平等指数（DII）衡量整体数字不平等程度，分析其与长期随访、生存率、预后及治疗之间是否存在显著回归趋势。DII通过美国社区调查和联邦通信委员会的17个普查区层面变量计算得出，这些变量分为基础设施接入和社会人口学特征两类，经排序后综合加权为复合评分。结果：随着整体数字不平等程度加剧，食管癌患者的长期随访时长（p<0.001）和生存率（p<0.001）显著下降。数字不平等程度越高，患者接受指南推荐手术切除的几率越低（OR 0.97，95% CI 0.95-0.99），初诊晚期分期的几率越高（OR 1.02，95% CI 1.00-1.05），接受指南推荐化疗的几率也越低（OR 0.97，95% CI 0.95-0.99）。结论：数字不平等显著加剧了美国食管癌患者诊疗的不利趋势，这为制定针对性干预措施提供了依据，同时从国家层面揭示了网络可及性对规范化诊疗影响的社会人口学特征。
The Impact of Digital Inequities on Esophageal Cancer Disparities in the US
肿瘤(癌症)患者之家