The impact of area deprivation index on treatment selection for small renal masses. state-wide analysis

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Eur Urol

Keywords

Urology & Nephrology

Abstract

Introduction & Objectives: Socioeconomic disparities influence oncological outcomes of patients of small renal masses (SRMs), yet their role in treatment selection for this kind of patients remains unclear. We tested the hypothesis that lower socio-economic status might lead lower odds of receiving nephron sparing treatment. Materials & Methods: We retrieved data on patients diagnosed with SRMs (≤3 cm) between 2004–2019 from Michigan Department of Health and Human Services database. The primary endpoint was type of treatment received, selecting among non-active treatment (NAT), partial nephrectomy (PN), radical nephrectomy (RN), and ablative therapy (AT). A logistic regression adjusted for demographic and clinical covariates assessed the impact of Area Deprivation Index (a score encompassing 17 different features assessing the level of socioeconomic deprivation of a neighborhood) on treatment selection. The more deprived an area is, the higher is ADI percentile will be when compared to national level. The restricted cubic spline method was used to calculate and to plot the predicted treatment probabilities based on ADI percentile. Results: Our cohort consisted of 5,220 patients, stratified into ADI quartiles. Median age at diagnosis was 62 years (IQR 54- 71), with most patients being male (60.7%). Tumors were mainly 2–3 cm in size (55.8%) without significant differences among ADI quartiles (p=0.52). Most patients received active treatment (88.6%), particularly, 48.4% received partial nephrectomy, 26.7% radical nephrectomy, and 13.5% ablative therapy. At the multinominal logistic regression adjusted for Age, Sex, Race, Insurance and Lesion Dimensions, ADI emerged as an independent predictor of undergoing RN rather than AT and PN (OR: 0.95; 95% CI 0.92 – 0.98; p =0.001 and OR: 0.94; 95% CI 0.90 – 0.98; p =0.007). Treatment probabilities shifted with rising ADI, showing decreasing use of PN and AT and increasing use of RN or NAT. Specifically, for every 10- point increase in ADI, the probability of receiving PN and AT decreased by 5% and 6%, respectively, compared to RN. The restricted cubic spline method showed a 10% difference in RN prediction between the 10th and the 90th percentile. Conclusions: ADI independently predicts treatment selection. Higher deprivation correlates with greater use of RN, suggesting inequities in SRM treatment selection depending on socio-economic status.

Volume

89

First Page

1

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