e18530 Background: While disparities in pancreatic cancer (PC) are documented, it is unclear whether these inequities occur at the time of diagnosis or throughout treatment. We hypothesize social determinants of health (SDH) such as income, education, race and insurance status are a) associated with a late diagnosis of PC (Stage IV vs Stages 0-III) and b) associated with overall survival (OS) in Stage IV patients. Methods: The National Cancer Database 2017 version was accessed. Primary outcome: diagnosis of Stage IV PC. Secondary outcome: OS. Primary predictors: race, income, education, insurance. Confounders: Charlson comorbidity score, age, sex. Univariate and multivariate regression models evaluated the association between SDH and a late diagnosis of PC. Univariate and multivariate Cox proportional hazards model examined OS. 95% Confidence Intervals were used. Results: 230,877 patients were included. Median 68 yrs, mean 67.3 SD(12.1). In univariate analysis, education (>93% high school completion (HSC) vs <82.4%, OR 0.93 [0.91 – 0.95]), income (>$63,333 vs<$40,277, OR 0.94 [0.92– 0.96]), and insurance (Private vs No, OR 0.70 [0.66 – 0.73]), decreased the odds of Stage IV PC. Black race was associated with higher odds of Stage IV PC (vs White, OR 1.11 [1.08 – 1.14]). In multivariate analysis, education and having insurance decreased the risk of a late diagnosis, whereas black race increased it (table). In univariate Cox analysis, higher income (>$63,333 (vs<$40,277), HR 0.82 [0.81– 0.83]), insurance (Private vs No, HR 0.77 [0.73 – 0.76]) and education (>93% HSC vs <82.4%, HR 0.87 [0.86 – 0.88]) improved OS. Black race was associated with poorer OS (vs White, HR 1.03 [1.02 – 1.05]). In multivariate Cox analysis, only higher income (>$63,333 (vs<$40,277), HR 0.87 [0.85 – 0.89]) and having insurance (Private vs No, HR 0.77 [0.74 – 0.79]) were associated with improved OS. Conclusions: SDH impacted the continuum of pancreatic neoplasia care, from diagnosis to treatment. Expanding insurance coverage could be an effective public health intervention to improve early diagnosis and survival rates.[Table: see text]