Racial and Socioeconomic Disparities in Bladder Cancer Survival: Analysis of the California Cancer Registry
Autor: | Keyhan Piranviseh, Francis A. Jefferson, Daniel A. Sidhom, Jeremy W. Martin, Argyrios Ziogas, Hoda Anton-Culver, Nobel Nguyen, Ramy F. Youssef, John M. Sung, Jenny Chang, Melissa Huang |
---|---|
Rok vydání: | 2019 |
Předmět: |
Male
030232 urology & nephrology California 0302 clinical medicine 80 and over Registries Cancer Aged 80 and over Middle Aged Prognosis Disease-specific survival Oncology 030220 oncology & carcinogenesis Socioeconomic status Public Health and Health Services Female Adult Urologic Diseases medicine.medical_specialty Race Urology Oncology and Carcinogenesis Basic Behavioral and Social Science Article Young Adult Insurance 03 medical and health sciences Clinical Research Behavioral and Social Science medicine Humans Oncology & Carcinogenesis Mortality Healthcare Disparities Survival analysis Neoplasm Staging Aged Bladder cancer business.industry Public health Advanced stage Health Status Disparities medicine.disease Cancer registry Socioeconomic Factors Urinary Bladder Neoplasms Managed care Neoplasm Grading business Medicaid Demography |
Zdroj: | Clinical genitourinary cancer, vol 17, iss 5 Clin Genitourin Cancer |
ISSN: | 1558-7673 |
Popis: | The California Cancer Registry was analyzed for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance types. Survival analyses were performed for 72,452 cases to determine the prognostic significance of racial and socioeconomic factors. Black race, low SES, and Medicaid insurance portend poorer outcomes. These findings reflect a multifaceted socioeconomic and public health conundrum. PURPOSE: To examine the California Cancer Registry (CCR) for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance in California patients. PATIENTS AND METHODS: The CCR was queried for bladder cancer cases in California from 1988 to 2012. The primary outcome was disease-specific survival (DSS), defined as the time interval from date of diagnosis to date of death from bladder cancer. Survival analyses were performed to determine the prognostic significance of racial and socioeconomic factors. RESULTS: A total of 72,452 cases were included (74.5% men, 25.5% women). The median age was 72 years (range, 18–109 years). The racial distribution among the patients was 81% white, 3.8% black, 8.8% Hispanic, 5.2% Asian, and 1.2% from other races. In black patients, tumors presented more frequently with advanced stage and high grade. Medicaid patients tended to be younger and had more advanced-stage, higher-grade tumors compared to patients with Medicare or managed care (P < .0001). Kaplan-Meier analysis demonstrated significantly poorer 5-year DSS in black, low SES, and Medicaid patients (P < .0001). When controlling for stage, grade, age, and gender, multivariate analysis revealed that black race (DSS hazard ratio = 1.295; 95% confidence interval, 1.212–1.384), low SES (DSS hazard ratio = 1.325; 95% confidence interval, 1.259–1.395), and Medicaid insurance (DSS hazard ratio = 1.349; 95% confidence interval, 1.246–1.460) were independent prognostic factors (P < .0001). CONCLUSION: An analysis of the CCR demonstrated that black race, low SES, and Medicaid insurance portend poorer DSS. These findings reflect a multifaceted socioeconomic and public health conundrum, and efforts to reduce inequalities should be pursued. |
Databáze: | OpenAIRE |
Externí odkaz: |