Socioeconomic disparities and MIBC survival outcome-An analysis of a statewide cohort.

PURPOSE

Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy with limited survival improvements despite advancements in treatment. Socioeconomic disparities significantly affect patient outcomes, yet the Area Deprivation Index (ADI), a robust measure of socioeconomic status, has been underexplored in MIBC. This study evaluates the association between ADI and cancer-specific mortality (CSM) in MIBC.

MATERIALS AND METHODS

We retrospectively reviewed patients with MIBC (≥ T2; Any N; Any M) from the Michigan Department of Health and Human Services database (2004-2019). ADI scores were assigned based on residential census block groups and stratified into quartiles, with the 4th quartile (ADI 75-100) being the most deprived. Cumulative incidence functions compared CSM between quartiles, and competing-risk regression analysis assessed the association between ADI and CSM after adjusting for covariates.

RESULTS

Among 6120 patients (90% Non-Hispanic Whites; median age 73 [IQR 64-81]), most resided in metropolitan areas (80%) and were insured through Medicare (35%). Patients were distributed across ADI quartiles: 437 (1st), 1442 (2nd), 2171 (3rd), and 2070 (4th). At 10 years, CSM rates were 50%, 52%, 54%, and 55% for the 1st, 2nd, 3rd, and 4th quartiles, respectively (p = 0.01). Patients in the 3rd and 4th quartiles had 1.25 (HR 1.25, 95% CI 1.07-1.47, p = 0.016) and 1.30 (HR 1.30, 95% CI 1.11-1.54, p = 0.005) higher risks of CSM than those in the 1st quartile.

CONCLUSIONS

Higher ADI was associated with increased CSM in our cohort. Further studies are needed to explore potential causal mechanisms.