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
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