Evaluation of the association of health care system access with kidney cancer surgical outcomes for hispanic and non-hispanic white patients

• Published in: Urologic oncology 2021-12, Vol.39 (12), p.837.e1-837.e7
• Main Authors: Javier-DesLoges, Juan F., Meagher, Margaret F., Walia, Arman, Nguyen, Mimi V., Perry, John M., Narasimhan, Rekha S., Hakimi, Kevin, Soliman, Shady, Yuan, Julia, Chakoumakos, Madison A., Ghali, Fady, Patel, Devin N., Wan, Fang, Murphy, James D., Derweesh, Ithaar H.
• Format: Article
• Language: English
• Subjects: Cancer specific survival; Carcinoma, renal cell; Clinical staging; Female; Health disparities; Health Services Accessibility - standards; Healthcare Disparities - standards; Hispanic or Latino; Humans; Kidney Neoplasms - epidemiology; Kidney Neoplasms - surgery; Male; Middle Aged; Nephrectomy; Overall survival; Retrospective Studies; Whites
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2021.08.021

•The impact of healthcare access on Renal Cell Carcinoma surgical outcomes is unknown.•Hispanic patients were more likely to live in underserved areas and have more advanced disease.•Hispanic patients had non-inferior 5-year survival outcomes after surgery.•Access to tertiary academic referral centers may help mitigate environmental disparities. To determine the impact of health care system access on outcomes for Hispanic and Non-Hispanic White patients with renal cell carcinoma (RCC). We retrospectively analyzed Hispanic and non-Hispanic White patients diagnosed with localized RCC between 2007 and 2020. We used Health Resources and Services Administration criteria to identify patients living in Medically Underserved Areas (MUA). Primary outcome all-cause mortality and cancer-specific survival using Log Rank test on Kaplan Meier Analysis. Secondary outcome was all-cause mortality and cancer specific survival on Cox Regression when adjusting for risk factors. We analyzed 774 patients, 246 (31.8%) Hispanic patients and 528 (68.2%) Non-Hispanic White patients. Hispanic ethnicity was associated with lower risk of ACM (HR 0.53, P = 0.019) and there was no difference for cancer specific survival (HR 0.57, P = 0.059). Living in a MUA was associated with worse all-cause mortality (P = 0.010) but not cancer specific survival (CSS) (P = 0.169). Comparing Hispanic and Non-Hispanic Whites, KMA revealed no difference in 5-year all-cause mortality (83.1% vs. 78.8%, P = 0.254) and 5-year CSS (85.7% vs. 85.4%, P = 0.403). Hispanics had lower all-cause mortality risk and no significant differences in 5-year overall survival and CSS compared to non-Hispanic Whites. Our findings indicate that tertiary referral centers may help mitigate inequalities in access to care.