PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-03 NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE ASSOCIATED WITH INCREASED MORTALITY FOLLOWING RADICAL CYSTECTOMY Jacob Knorr, Rebecca Campbell, Jarrod Dalton, Prithvi Murthy, Georges-Pascal Haber, and Byron Lee Jacob KnorrJacob Knorr More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Jarrod DaltonJarrod Dalton More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent efforts to optimize recovery following radical cystectomy have not led to substantial improvement in complication rates. Though clinical risk factors have been routinely studied, the contribution of socioeconomic factors has not been well-defined. The Area Deprivation Index (ADI) is derived from 17 U.S. Census variables in income, education, employment, and housing, and describes neighborhood disadvantage down to the geographic block-group (600-3,000 people). Our objective was to examine associations between ADI and perioperative outcomes following radical cystectomy. METHODS: A prospective database of radical cystectomy patients was queried from 2010-2018. Residential locations at time of surgery were geocoded using SQL Server with TIGER/LINE census data to assign a block-group for each patient. National ADI percentile ranks were imported from the Neighborhood Atlas. Patients were stratified by national ADI quartile with the 1st quartile representing least disadvantaged and 4th quartile the greatest disadvantaged. Outcomes were compared using Cochran Armitage Trend or Kruskal-Wallis tests. RESULTS: The distribution of 906 patients across ADI quartiles was: 12.7%, 31.8%, 35.1%, and 20.4%. The 4th quartile was associated with younger age (p=0.01), black race (p=<0.0001), and active smoking (p=<0.0001). The 90-day (90d) mortality rates observed in the 1st and 4th quartiles were 0% (0/115) and 6.5% (12/185), respectively. ADI quartile was significantly associated with 30d (p=0.01) and 90d (p=0.002) mortality. When evaluating ADI as a continuous variable, the unit and range odds ratios for 90d mortality were 1.021 (CI: 1.004 - 1.04) and 8.11 (CI: 1.5 - 47.83), respectively. ADI was also associated with late (30-90d) complications (p=0.04), though there were no significant differences in 30 and 90d major complications, readmission rates, or length of stay between ADI quartiles. CONCLUSIONS: We present the first use of the Area Deprivation Index at the block-group level in Urology. ADI was significantly associated with late complication and 30 and 90d mortality, with nearly half of all 90d deaths occurring in the most disadvantaged ADI quartile. Our findings suggest that post-cystectomy morbidity and mortality may be partially attributable to socioeconomic factors. Source of Funding: CWRU CCC © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e833-e833 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Knorr More articles by this author Rebecca Campbell More articles by this author Jarrod Dalton More articles by this author Prithvi Murthy More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Expand All Advertisement Loading ...