49 PUBLIC VS. PRIVATE: A COMPARISON OF BLADDER CANCER OUTCOMES IN TWO HEALTH CARE SETTINGS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes1 Apr 201149 PUBLIC VS. PRIVATE: A COMPARISON OF BLADDER CANCER OUTCOMES IN TWO HEALTH CARE SETTINGS Eduardo Castro-Echeverry, Patrick Cockerill, Tien Ko, Curtis Wray, Lillian Kao, and Steven Canfield Eduardo Castro-EcheverryEduardo Castro-Echeverry Houston, TX More articles by this author , Patrick CockerillPatrick Cockerill Houston, TX More articles by this author , Tien KoTien Ko Houston, TX More articles by this author , Curtis WrayCurtis Wray Houston, TX More articles by this author , Lillian KaoLillian Kao Houston, TX More articles by this author , and Steven CanfieldSteven Canfield Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2651AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The effects of socioeconomic status on bladder cancer outcomes have not been well studied. We hypothesized that bladder cancer patients treated in a public hospital system would present at an advanced stage and have worse stage-adjusted survival than those treated in a private hospital system. METHODS Overall survival and advanced stage at diagnosis were compared in bladder cancer patients treated at two health care settings, one public and one private, between 1998 and 2010. Variables evaluated included stage and age at diagnosis, gender, and race. Univariate and multivariate logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards modeling were performed using SPSS. RESULTS A total of 149 public and 1,223 private hospital patients diagnosed with bladder cancer during this period were identified. Their demographic information, stage at diagnosis, and age at diagnosis are listed in Table 1. Public hospital patients were more likely to be from underrepresented races (p<0.001). Public hospital setting, female gender, and African-American race were associated with advanced stage (Stage IV) at diagnosis by logistic regression analysis (Table 2). After adjusting for stage, age, and race, public hospital setting was not associated with increased mortality (Table 3). Table 1. Demographic Characteristics for Public and Private Hospital Patients Public Private p value Count(%) Count(%) Sex Male 121(81.2) 911(74.5) 0.073 Female 28(18.8) 312(25.5) Race Caucasian 46(30.9) 970(79.8) 0.001 African American 43(28.9) 102(8.4) Hispanic 48(32.2) 72(5.9) Asian/Other 12(8) 71(5.8) Stage 0 46(36.5) 676(55.3) 0.001 I 25(19.8) 284(23.2) II 12(9.5) 155(12.7) III 16(12.7) 49(4.0) IV 27(21.4) 59(4.8) Mean Age (SD) 60(11) 69(12) <0.001 Table 2. Logistic regression for Stage 4 at Diagnosis Risk Factor OR 95% CI p value Public/Private 3.6 2.0–6.4 <0.001 Female/Male 1.8 1.1–2.9 0.02 Black/White 2.2 1.2–4.0 0.01 Table 3. Cox Proportional Hazards for Overall Survival Risk Factor HR 0.73–1.5 p value Stage (0 as reference) I 1.5 1.2–1.9 0.002 II 4.0 3.0–5.1 0.001 III 5.0 4.2–8.3 0.001 IV 9.0 6.6–12.2 0.001 Black/White 1.6 1.2–2.0 0.001 Public/Private 1.0 0.73–1.5 0.79 CONCLUSIONS While public hospital patients did present at an advanced stage, both private and public hospital patients had similar stage-specific survival rates. Future interventions which address barriers to timely diagnosis and treatment may have a significant impact on overall survival in public hospital systems. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e21 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eduardo Castro-Echeverry Houston, TX More articles by this author Patrick Cockerill Houston, TX More articles by this author Tien Ko Houston, TX More articles by this author Curtis Wray Houston, TX More articles by this author Lillian Kao Houston, TX More articles by this author Steven Canfield Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...