PD46-06 HOSPITAL SAFETY NET BURDEN IDENTIFIES DISPARITIES IN NON-DEFINITIVE MANAGEMENT AND SURVIVAL IN HIGH RISK LOCALIZED PROSTATE CANCER

Abstract

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making IV (PD46)1 Sep 2021PD46-06 HOSPITAL SAFETY NET BURDEN IDENTIFIES DISPARITIES IN NON-DEFINITIVE MANAGEMENT AND SURVIVAL IN HIGH RISK LOCALIZED PROSTATE CANCER Raj Bhanvadia, Fady Baky, Michael Chandra, Alex Kenigsberg, Yair Lotan, Jeffrey Howard, Xiaosong Meng, Aditya Bagrodia, Vitaly Margulis, and Solomon Woldu Raj BhanvadiaRaj Bhanvadia More articles by this author , Fady BakyFady Baky More articles by this author , Michael ChandraMichael Chandra More articles by this author , Alex KenigsbergAlex Kenigsberg More articles by this author , Yair LotanYair Lotan More articles by this author , Jeffrey HowardJeffrey Howard More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , and Solomon WolduSolomon Woldu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002060.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As Medicaid expansion nominally improves access to care – hospitals with high safety-net burden (SNB), defined as the proportion of Medicaid and uninsured patients cared for, may face resource constraints that impact treatment choice. Using the National Cancer Database (NCDB), we examined trends in the management of high risk localized PCa (hPCa) by SNB. We hypothesized patients treated at high SNB hospitals would be associated with non-definitive management and worse mortality. METHODS: NCDB was queried from 2004-2016 for localized (cT1-T4cN0cM0) hPCa with known treatment status. High risk disease was classified using current AUA risk criteria. Non-definitive management was defined as receipt of androgen deprivation therapy or watchful waiting. Definitive management was defined as receipt of radiation or radical prostatectomy. Hospital SNB (% Medicaid & uninsured) was divided into tertiles (low, moderate, high). Multivariate logistic regression models were constructed to predict odds of undergoing non-definitive management by SNB. Subgroup analysis were performed for patients ≤60 years old, and patients with private insurance. Cox hazards model evaluated association between overall mortality and SNB status. Multivariate analyses adjusted for race, income, insurance, region, facility type, stage, grade, PSA, and comorbidity. RESULTS: 160,412 patients met inclusion criteria. The proportion of Medicaid/uninsured at high-SNB hospitals was 11% vs 1.1% at low-SNB hospitals. Patients treated at high-SNB hospitals were older, lower income, and more likely to be non-white (p<0.01). High-SNB was independently associated with increased odds of non-definitive management (OR: 1.7, p<0.01). On sub-group analysis, high-SNB remained associated with increased odds of non-definitive management in patients ≤60 years (OR: 2.0, p<0.01) and among patients with private insurance (OR: 2.0, p<0.01). In patients undergoing definitive management, high-SNB was associated with worse overall mortality (OR: 1.04, p=0.05). CONCLUSIONS: Overall mortality for hPCa was worse at high-SNB hospitals when definitive management was pursued. SNB was associated with increased odds of non-definitive management for hPCa, including in patients ≤60 years old and those who presented with private insurance. These results were independent of common socioeconomic factors associated with worse outcomes, suggesting hospital resources may play a role in treatment decisions. This finding has significant implications as healthcare access expands. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e750-e750 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raj Bhanvadia More articles by this author Fady Baky More articles by this author Michael Chandra More articles by this author Alex Kenigsberg More articles by this author Yair Lotan More articles by this author Jeffrey Howard More articles by this author Xiaosong Meng More articles by this author Aditya Bagrodia More articles by this author Vitaly Margulis More articles by this author Solomon Woldu More articles by this author Expand All Advertisement Loading ...