Background Neighborhood Deprivation (ND) indices serve as indicators of socioeconomic status and are recognized determinant of survival across multiple cancer types. Objective To determine the potential effect of ND on urothelial bladder cancer survival outcomes using a California-specific measure, the Healthy Places Index (HPI). Methods We queried our institutional database for patients who underwent radical cystectomy from 2013 to 2019. Patients were categorized into HPI quartiles based on their residential areas, with Q1 representing the most disadvantaged and Q4 the least disadvantaged. Multivariable logistic regression was used to identify predictors of adverse pathological features. Multivariable cox regression was utilized to evaluate the association of HPI with overall survival (OS) and recurrence free survival (RFS). Results A total of 729 patients were included in our analysis. Belonging to the most disadvantaged quartile (Q1) was associated with higher odds of lymphovascular invasion (HR 1.94, p < 0.001), and extravesical disease (HR 1.87, p < 0.001) at presentation, compared to the least deprived quartile (Q4). Survival analyses showed that worse ND was independently associated with worse OS (Q1 vs Q4: HR: 1.76, 95% CI: 1.18–2.62, p = 0.006) after adjusting for age, extravesical disease, node-positivity, and lymphovascular invasion. OS was positively associated with the education, economic, and transportation subdomains of HPI in univariable analyses. Conclusions Greater ND is associated with adverse pathology on presentation and worse OS following radical cystectomy for UBC. Larger prospective studies are warranted to further assess the influence of social disparities on survival outcomes following RC.
Dadabhoy et al. (Mon,) studied this question.