USC Institute of Urology, Los Angeles, CA; University of Southern California, Los Angeles, CA.
USC Institute of Urology, Los Angeles, CA; University of Southern California, Los Angeles, CA; USC/Norris Comprehensive Cancer Center, Los Angeles, CA.
Urol Oncol. 2019 Oct;37(10):784-790. doi: 10.1016/j.urolonc.2019.04.021. Epub 2019 May 8.
Bladder cancer is the fourth most common cancer among males and poses a significant financial burden, yet there are no large-scale studies focused on the correlation between socioeconomic (SES) and insurance status and bladder cancer outcomes. The objective of this study was to determine the effect of SES and insurance type on outcomes in bladder cancer.
A population-based search was performed using the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 database. Patients aged 18 or older and diagnosed with bladder cancer between 2011 and 2015 were identified. Data on patient demographics, SES features, insurance status, tumor characteristics, and survival were collected. A county-level SES measure was created in a method consistent with prior literature. Primary outcomes were overall survival (OS) and disease-specific survival (DSS).
A total of 91,308 patients were identified. Factors predictive of having muscle invasive disease included having Medicaid insurance, having no insurance, and being in the lowest SES quartile (all P < 0.001). Having Medicaid or no insurance was predictive of having node positive or metastatic disease (P < 0.001). Independent of T stage, patients in the lowest and second lowest SES quartiles had worse OS (P = 0.004 and P = 0.022, respectively) and DSS (P < 0.001 for both). Patients with Medicaid or no insurance had worse OS and DSS (P < 0.001 for all).
Lower SES status, Medicaid insurance, and having no insurance were all predictive of having higher tumor stage. Independent of tumor stage, being of lower SES, having Medicaid insurance, and having no insurance predicted worse OS and DSS.
膀胱癌是男性中第四大常见癌症，给患者带来了沉重的经济负担，但目前尚无针对社会经济地位（SES）和保险状况与膀胱癌结局之间相关性的大规模研究。本研究旨在确定 SES 和保险类型对膀胱癌结局的影响。
使用国家癌症研究所的监测、流行病学和最终结果 18 数据库进行了基于人群的搜索。确定了年龄在 18 岁或以上且在 2011 年至 2015 年间被诊断为膀胱癌的患者。收集了患者人口统计学、SES 特征、保险状况、肿瘤特征和生存数据。使用与既往文献一致的方法创建了县级 SES 衡量标准。主要结局是总生存（OS）和疾病特异性生存（DSS）。
共确定了 91308 名患者。具有肌层浸润性疾病的预测因素包括拥有医疗补助保险、没有保险和处于 SES 最低四分位数（均 P <0.001）。拥有医疗补助保险或没有保险是预测淋巴结阳性或转移性疾病的因素（P <0.001）。与 T 分期无关，SES 最低和第二低四分位数的患者 OS 较差（P = 0.004 和 P = 0.022，分别）和 DSS 较差（均 P <0.001）。拥有医疗补助保险或没有保险的患者 OS 和 DSS 更差（均 P <0.001）。
SES 地位较低、医疗补助保险和没有保险都是预测肿瘤分期较高的因素。独立于肿瘤分期，SES 较低、拥有医疗补助保险和没有保险均预测 OS 和 DSS 较差。
