定义在邻域层面上接受复杂癌症手术的差异。关于接受手术的地理变化在复杂胃肠道癌症患者中的情况，尤其是在小的地理范围内，目前了解甚少。本研究包括2009年至2018年期间在俄亥俄州癌症发病监测系统中被诊断为五种侵袭性非转移性复杂胃肠道癌症（食道、胃、胰腺、胆管、肝脏）的个体。为了保护患者隐私，我们使用Max-p-regions方法，将美国普查区结合成包含最低手术病例数量（n=11）的最小地理区域，并将这些新区域称为“MaxTracts”。MaxTracts计算了年龄调整的手术率，热点分析识别出高和低手术率的聚类。我们使用美国普查和CDC PLACES来比较高和低手术率群体之间的社区特征。本研究包括33,091名在俄亥俄州的1,006个MaxTracts中患有复杂胃肠道癌症的个体。每个MaxTract接受手术的比例从20.7％到92.3％不等，中位数（四分位距）为48.9％（42.4-56.3）。低手术集群主要位于城市核心区和阿巴拉契亚地区，而高手术集群主要位于郊区。低手术聚类与高手术聚类在许多方面有所不同，包括贫困率较高（23％对12％），结婚家庭较少（40％对50％），吸烟率较高（25％对19％；所有P<0.01）。对邻域层面上接受潜在治愈手术的差异的理解将指导未来的外展和基于社区的干预，以减少治疗的不平等。类似的方法可以用于针对其他治疗阶段和其他癌症的治疗。版权所有 © 2023 Wolters Kluwer Health，Inc. 保留所有权利。

To define neighborhood-level disparities in the receipt of complex cancer surgery.Little is known about the geographic variation of receipt of surgery among patients with complex gastrointestinal (GI) cancers, especially at a small geographic scale.This study included individuals diagnosed with five invasive, non-metastatic, complex GI cancers (esophagus, stomach, pancreas, bile ducts, liver) from the Ohio Cancer Incidence Surveillance System during 2009 to 2018. To preserve patient privacy, we combined US census tracts into the smallest geographic areas that included a minimum number of surgery cases (n=11) using the Max-p-regions method and called these new areas "MaxTracts". Age-adjusted surgery rates were calculated for MaxTracts, and the Hot Spot analysis identified clusters of high and low surgery rates. US Census and CDC PLACES were used to compare neighborhood characteristics between the high- and low-surgery clusters.This study included 33,091 individuals with complex GI cancers located in 1,006 MaxTracts throughout Ohio. The proportion in each MaxTract receiving surgery ranged from 20.7% to 92.3% with a median (IQR) of 48.9% (42.4-56.3). Low-surgery clusters were mostly in urban cores and the Appalachian region, whereas high-surgery clusters were mostly in suburbs. Low-surgery clusters differed from high-surgery clusters in several ways, including higher rates of poverty (23% vs. 12%), fewer married households (40% vs. 50%), and more tobacco use (25% vs. 19%; all P<0.01).This improved understanding of neighborhood-level variation in receipt of potentially curative surgery will guide future outreach and community-based interventions to reduce treatment disparities. Similar methods can be used to target other treatment phases and other cancers.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.