Social Determinants Of Health Are Associated With Mortality In Muscle-Invasive Bladder Cancer

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (PD03)1 Sep 2021PD03-04 SOCIAL DETERMINANTS OF HEALTH ARE ASSOCIATED WITH MORTALITY IN MUSCLE-INVASIVE BLADDER CANCER David T. Miller, Zhaojun Sun, Valentina Grajales, Anup A. Shah, Kelly R. Pekala, Benjamin J. Davies, Lindsay M. Sabik, and Bruce L. Jacobs David T. MillerDavid T. Miller More articles by this author , Zhaojun SunZhaojun Sun More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Anup A. ShahAnup A. Shah More articles by this author , Kelly R. PekalaKelly R. Pekala More articles by this author , Benjamin J. DaviesBenjamin J. Davies More articles by this author , Lindsay M. SabikLindsay M. Sabik More articles by this author , and Bruce L. JacobsBruce L. Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001967.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social determinants of health can influence an individual’s life expectancy. We sought to examine the association of socioeconomic status, rural-urban location, and type of insurance with overall and cancer-specific mortality among patients with muscle-invasive bladder cancer. METHODS: Using the Pennsylvania Cancer Registry, we identified all patients diagnosed with non-metastatic MIBC between 2010-2016 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 as ADI 1-4 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 mortality and cancer specific mortality adjusting for age, sex, race, stage, treatment, rural-urban classification, insurance and ADI. RESULTS: We identified 3,362 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 all statistically significant independent predictors of greater overall mortality (p<0.05). Female sex was also associated with both worse overall mortality (HR 1.26) and bladder cancer-specific mortality (HR 1.32) (p