Insurance Type and Area Deprivation Are Associated With Worse Overall Mortality for Patients With Muscle-invasive Bladder Cancer.

Autor: Miller DT; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: millerdt@upmc.edu., Sun Z; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Grajales V; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA., Pekala KR; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA., Eom KY; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Yabes J; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Davies BJ; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA., Sabik LM; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Jacobs BL; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Jazyk: angličtina
Zdroj: Urology [Urology] 2023 Jul; Vol. 177, pp. 81-88. Date of Electronic Publication: 2023 Apr 05.
DOI: 10.1016/j.urology.2023.02.045
Abstrakt: Objective: To examine the association of area-level socioeconomic status, rural-urban residence, and type of insurance with overall and cancer-specific mortality among patients with muscle-invasive bladder cancer.
Methods: Using the Pennsylvania Cancer Registry, which collects demographic, insurance, and clinical information on every patient with cancer within the state, we identified all patients diagnosed with non-metastatic muscle-invasive bladder cancer between 2010 and 2016 based on clinical and pathologic staging. We used the Area Deprivation Index (ADI) as a surrogate for socioeconomic status and Rural-Urban Commuting Area codes to classify urban, large town, and rural communities. ADI was reported in quartiles, with 4 representing the lowest socioeconomic status. We fit multivariable logistic regression and Cox models to assess the relationship of these social determinants with overall and cancer-specific survival adjusting for age, sex, race, stage, treatment, rural-urban classification, insurance and ADI.
Results: We identified 2597 patients with non-metastatic muscle-invasive bladder cancer. On multivariable analysis, Medicare (hazards ratio [HR] 1.15), Medicaid (HR 1.38), ADI 3 (HR 1.16) and ADI 4 (HR 1.21) were independent predictors of greater overall mortality (all P < 0.05). Female sex and receipt of non-standard treatment were associated with increased overall mortality and bladder cancer-specific mortality. There was no significant difference in both overall and cancer-specific survival between patients who were non-Hispanic White compared to non-White or between those from urban areas, large towns, or rural locations.
Conclusion: Lower socioeconomic status and Medicare and Medicaid insurance were associated with a greater risk of overall mortality while rural residence was not a significant factor. Implementation of public health programs may help reduce the gap in mortality for low SES at-risk populations.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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