The impact of socioeconomic disparities on the quality of surgery in patients with Muscle-Invasive Bladder Cancer (MIBC): A statewide cohort analysis
Recommended Citation
Bertini A, Dinesh A, Finocchiaro A, Vigano S, Cusmano NB, Robinson B, Mssika A, Guivatchian E, Lughezzani G, Buffi N, Di Trapani E, Ficarra V, Salonia A, Briganti A, Montorsi F, Sood A, Rogers C, Abdollah F. The impact of socioeconomic disparities on the quality of surgery in patients with Muscle-Invasive Bladder Cancer (MIBC): A statewide cohort analysis. Eur Urol 2025; 87(S1):914.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: There is scarcity of data in literature regarding the association between socioeconomic status, as measured by Area Deprivation Index (ADI), and the quality of care in Bladder Cancer (BCa). In this report, we investigated the impact of ADI on receiving adequate Pelvic Lymph Node Dissection (PLND) for Muscle Invasive Bladder Cancer (MIBC), in a North-American cohort. Materials & Methods: The Michigan Department of Health and Human Services (MDHHS) was queried to identify men with a histologically confirmed MIBC (pT>2) at Transurethral resection of the bladder (TURB) and absence of metastasis (M0) between 2004 and 2018. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into two groups according to ADI score, where the ADI > 50 one represented those living in the most deprived areas. Logistic regression analysis tested the impact of ADI on receiving any PLND and "Adequate PLND", which was defined as removing at least 15 lymph nodes at time of surgery. Results: Our final cohort consisted of 5442 patients with non-metastatic MIBC, 8% of whom were NHB. Median (IQR) age was 73 (64-81) years and median (IQR) follow-up was 20 (12.6-38.6) months. Patients in the most disadvantage group (ADI> 50) were more likely to be younger (73 vs 74 years, p=0.006) and NHB (10% vs 2.4%, p<0.001), reporting higher probability to be diagnosed with pT3-4 MIBC (34 vs 33%, p=0.001) and not to undergo surgical treatment (2.7% vs 1.5%, p=0.002), compared to those living in most advantaged areas. At MVA, although the association between ADI score and the probability to undergo any PLND was not statistically significant (OR: 0.88, 95% CI, 0.76 - 1.01, p=0.067), patients with ADI > 50 were less likely to receive adequate PLND (OR: 0.80, 95% CI, 0.65-0.98, p=0.028). Conclusions: Although patients living in more deprived areas seem to present with more advanced disease, they do not seem to receive adequate PLND for MIBC. The impact of such a phenomenon on cancer control outcomes needs to be further investigated. Our study underscores the silent barrier that socioeconomic deprivation poses to proper surgical treatment for MIBC and echo the call for tailored interventions to bridge this gap.[Figure presented].
Volume
87
Issue
S1
First Page
914
