Pd05-09 Patients With Upper Tract Urothelial Carcinoma at Minority Serving Hospitals Are Less Likely to Undergo Definitive Treatment

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes I (PD05)1 May 2024PD05-09 PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA AT MINORITY SERVING HOSPITALS ARE LESS LIKELY TO UNDERGO DEFINITIVE TREATMENT Christopher S. Connors, Micah Levy, Daniel Wang, Juan Sebastian Arroyave, Olamide Omidele, Nikit Venishetty, and Michael Palese Christopher S. ConnorsChristopher S. Connors , Micah LevyMicah Levy , Daniel WangDaniel Wang , Juan Sebastian ArroyaveJuan Sebastian Arroyave , Olamide OmideleOlamide Omidele , Nikit VenishettyNikit Venishetty , and Michael PaleseMichael Palese View All Author Informationhttps://doi.org/10.1097/01.JU.0001008624.07191.ab.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States, often referred to as minority serving hospitals (MSH). Given that Black patients have been shown to suffer worse outcomes from upper tract urothelial carcinoma (UTUC), understanding if this disparity is related to differences in care at MSHs is crucial towards alleviating it. In this study, we investigate the effect of treatment at a MSH on the receipt of definitive treatment for UTUC. METHODS: The National Cancer Database was queried for non-metastatic UTUC cases from 2004 to 2020. Similar to prior studies, a MSH was defined as a facility in the top decile of proportion of Black and Hispanic patients in the UTUC cohort. Definitive treatment was defined as local excision for low-risk UTUC or radical nephroureterectomy for high-risk UTUC. Demographics and clinical information were compared between patients at MSHs and non-MSHs. Univariate and multivariate logistic regression was performed to identify predictors of definitive treatment. RESULTS: 29,532 non-metastatic UTUC patients were identified (MSH=2058; non-MSH=27,474). Compared to a non-MSH, patients at a MSH were more likely to be uninsured (4.3 vs 1.2%) and be treated at an academic institution (40.5 vs 34.9%), all p<0.001. Moreover, the average time from diagnosis to definitive treatment was comparable between groups (MSH: 44.6 days, non-MSH: 43.6 days, p=0.685). Rates of definitive treatment were lower at MSHs compared to non-MSHs (84.1 vs 88.2%, p<0.001). On univariate analysis, receiving care at a MSH was a negative predictor of definitive treatment (OR=0.785, p<0.001). On multivariate analysis, treatment at a MSH continued to negatively predict receipt of definitive treatment (OR=0.447, p=0.020) [Table 1]. Furthermore, increased UTUC surgery volume at the hospital and higher T stage predicted definitive treatment while Medicaid/Medicare or no insurance and lymph node involvement were negative predictors. CONCLUSIONS: Patients with UTUC at a MSH are less likely to undergo definitive treatment. This association is modulated by insurance status and facility volume which suggests that a combination of health access, socioeconomic, and facility-level factors contribute towards racial disparities in UTUC care. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e93 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Christopher S. Connors More articles by this author Micah Levy More articles by this author Daniel Wang More articles by this author Juan Sebastian Arroyave More articles by this author Olamide Omidele More articles by this author Nikit Venishetty More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF downloadLoading ...