Social and Environmental Risk Factors at the Census Tract Levels for Patients Undergoing Radical Cystectomy for Urothelial Carcinoma in Rhode Island in the Last 20 Years
Borivoj Golijanin, BS1, Sarah Andrea, PhD1, Justin Bessette, BS1, Rebecca Ortiz, BA1, Philip Caffery, PhD1, Timothy O'Rourke, MD2, Christopher Tucci, MS, RN-BC, CURN, NE-BC1, Ali Amin, MD3, Dragan J. Golijanin, MD1.
1Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2The Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA, 3Department of Pathology and Laboratory Medicine, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA.
BACKGROUND: Tobacco smoking and occupational exposure are well documented urothelial carcinoma (UC) risk factors. Potentially upstream neighborhood-level factors are underexplored. We examined the association between sociodemographic and pollution composition and incidence of UC treated by radical cystectomy (RC) and overall survival (OS) in Rhode Island.
METHODS: 484 patients underwent RC from 1/2000 to 12/2020 at Brown University affiliated hospitals. Patient addresses were linked to census tractlevel data on neighborhood sociodemographic composition and locations of leaking underground storage tanks, superfund sites, sanitary waste sites, and active solid waste facilities. Using Poisson and Cox proportional hazards models, we assessed incidence of RC and OS as a function of neighborhood pollution, area deprivation index (ADI), poverty, and racial composition quartiles in separate models adjusted for year and age at time of RC.
RESULTS: Average age was 68 years, 73% men, and 90% white, with clinical stage T2 in 32%, Tis in 5%, Tx in 8%, and 3% had no information. Likelihood of RC positively correlated with greater neighborhood pollution (RR for 4th vs 1st quartile:1.39, 95% CI:1.08,1.79), predominance of white population (RR for 4th vs. 1st quartile:1.94, 95% CI:1.41,2.66) and negatively with greater poverty (RR for 4th vs. 1st quartile: 0.44, 95% CI:0.33, 0.58). Five-year OS rate was 56%, in neighborhoods with highest poverty rates (Q4) was 45%, and in neighborhoods with lowest rates of poverty (Q1) was 62%. Compared with Q1, the hazard ratio for those in Q4 poverty neighborhoods was 1.72 (95% CI:1.16,2.55).
CONCLUSIONS: Inequalities in social determinants of health influence incidence and outcomes of UC patients undergoing RC. Patients undergoing RC were more likely to be white and living in affluent neighborhoods (Figure 1), however, this could be an artifact of selective survival. Those living in neighborhoods with greater number of pollutants underwent RC at greater rates (Figure 2). Risk of death in the first five years following RC was greatest for those living in neighborhoods with low socioeconomic status. Further research is needed to study contextual factors defining the differences in RC use and OS of patients with UC. Health policies and screening programs can target these high-risk UC hot-spots in order to improve earlier detection and patient outcomes.
Back to 2021 Abstracts