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Purpose <p>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.</p> Materials and methods <p>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.</p> Results <p>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 (<i>p</i> = 0.01). Patients in the 3rd and 4th quartiles had 1.25 (HR 1.25, 95% CI 1.07–1.47, <i>p</i> = 0.016) and 1.30 (HR 1.30, 95% CI 1.11–1.54, <i>p</i> = 0.005) higher risks of CSM than those in the 1st quartile.</p> Conclusions <p>Higher ADI was associated with increased CSM in our cohort. Further studies are needed to explore potential causal mechanisms.</p>

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

  • 期刊论文

  • 发表日期：

    2025年6月2日

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  • Alessio Finocchiaro,
  • Anna Tylecki,
  • Alex Stephens,
  • Silvia Viganó,
  • Alessandro Bertini,
  • Alberto Briganti,
  • Francesco Montorsi,
  • Andea Salonia,
  • Giovanni Lughezzani,
  • Nicoló Buffi,
  • Vincenzo Ficarra,
  • Ettore Di Trapani,
  • Akshay Sood,
  • Craig Rogers,
  • Firas Abdollah

摘要

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.