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.
Urologic oncology. 2019 May 08 [Epub ahead of print]
Azadeh Nazemi, Saum Ghodoussipour, Shane Pearce, Sumeet Bhanvadia, Siamak Daneshmand
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., USC Institute of Urology, Los Angeles, CA; University of Southern California, Los Angeles, CA; USC/Norris Comprehensive Cancer Center, Los Angeles, CA. Electronic address: .