Disparities in overall and urothelial carcinoma specific mortality associated with healthcare insurance status

Abstract

OBJECTIVE:We investigated the association of insurance status with urothelial carcinoma (UC) mortality outcomes to further understand the relationship of socioeconomic status (SES) and UC disease outcomes. MATERIALS AND METHODS:We performed an IRB approved, retrospective review of patients newly diagnosed with bladder UC in the years 2004 and 2005. Data were collected from January 2004 to September 2014 regarding insurance, demographics, operations, surgical pathology, and follow-up care. Insurance was characterized as lower SES and high SES based on election to utilize private vs. public sources as well as purchase of supplemental Medicare coverage. RESULTS:A total of 213 patients were examined with a mean follow-up of 84 months. The high SES and lower SES insurance groups presented with similar disease stage (26% ≥ T2 in high SES insurance vs. 33%, P = 0.1) and grade (60% high-grade in high SES vs. 59%, P = 0.9). Significant differences were seen in one-year UC specific mortality (5% high SES insurance vs. 21%, P = 0.003) and five-year UC specific mortality (19% high SES insurance vs. 42%, P = 0.007). Upon multivariate analysis controlling for age, gender, Charlson comorbidity score, grade, stage, and metastatic disease on presentation, insurance type remained a significant risk factor for increased mortality from UC (HR = 2.6, P < 0.01). Kaplan-Meier analysis showed a persistence of lower survival with time. CONCLUSIONS:We found disparities in mortality from bladder cancer associated with source of insurance. This association persisted upon multivariate analysis as an independent risk factor for death from bladder UC.

Epidemiology, Incidence and Mortality of Bladder Cancer and their Relationship with the Development Index in the World

“…A strong correlation between socioeconomic status and survival of patients with bladder cancer has been observed in other studies. In other words, the increase in premature death was seen in patients with low socioeconomic status than those with higher socioeconomic status (Siddiqui et al, 2015). The patients with low socio-economic status experience lower survival due to reduced access to health care, biology of the disease, environmental factors, exposure to tobacco, and health habits (Shackley and Clarke, 2005).…”

Impact of Socioeconomic Status on Patient Adherence in Managing Renal Masses

“…17 While treatment methods may be guided by physicians, patient adherence with future appointments more closely reflects individual patient factors and SDOH. [18][19][20][21][22][23] Adherence is likely significantly associated with an individual's ability to access care, highlighting institutional and community disparities. Our results indicate adherence outcomes are significantly associated with a patient's SES based on income and ADI, even after controlling for race/ethnicity.…”

“…Extensive research on SDOH has demonstrated that patients with higher SDOH needs have decreased illness prevention and disease management, while also having higher rates of no-shows and emergency room utilization. [18][19][20][21][22][23] In fact, a systematic review of pediatric weight-management programs found that Black participants had higher dropout rates, and low family income was associated with decreased adherence with management protocols. 24 Our work demonstrates that similar disparities exist for patients undergoing renal mass management.…”

Lessons Learned: Social Determinants of Health Screening Pilot in 2 Urology Clinics

“…4–6 Within urology specifically, worsened outcomes due to socioeconomic disadvantages have been documented in the context of bladder cancer, prostate cancer, kidney cancer and stone disease, to name a few. 7–10…”