The Impact of Social Inequalities on the Survival of Patients With Pancreatic Cancer: Analysis of a Cohort of 1,426 Cases in Brazil

Background Pancreatic cancer remains one of the most lethal malignancies worldwide, with a five-year survival rate below 10%. In Brazil, significant regional and social inequalities shape access to diagnostic and therapeutic services, leading to disparities in survival outcomes. This study aimed to evaluate healthcare-related factors associated with survival among Brazilian patients with pancreatic cancer, focusing on institutional barriers, race, and health system entry point. Methods We conducted a retrospective cohort study of 1,426 patients diagnosed with pancreatic adenocarcinoma at the National Cancer Institute (INCA 1, Brazil) between 2000 and 2023. Data were obtained from the Hospital Cancer Registry. Survival analyses were structured into three temporal models: (1) consultation–death, (2) diagnosis–death, and (3) treatment–death. Kaplan–Meier curves and log-rank tests were used for bivariate analysis, and Cox proportional hazards models were applied to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results Median survival was 81 days from diagnosis to death and 75 days from first consultation to death. After treatment initiation, median survival increased to 170 days. In pre-treatment models, survival was significantly influenced by race, referral source, and prior diagnosis/treatment. Black patients (median 94.3 days) had shorter survival than white patients (131.5 days; p < 0.001). Patients entering care via the public health system (SUS) survived less (101.4 days) than those treated outside SUS (123.2 days; p = 0.05). Institutional follow-up was the strongest protective factor, associated with survival differences exceeding 260 days. In the treatment–death model, most inequalities attenuated, but institutional follow-up remained highly predictive (451.3 vs. 121.3 days; HR = 2.28; 95% CI: 1.34–3.89). Conclusions Social and institutional inequalities significantly affect survival in pancreatic cancer, particularly before treatment initiation. Race, referral source, and prior diagnosis/treatment strongly influenced prognosis in early stages, but disparities decreased after specialized therapy began. Institutional follow-up emerged as the main determinant of improved survival, highlighting the importance of timely diagnosis, equitable referral pathways, and patient-centered continuity of care to reduce health inequities in highly lethal cancers.