Sociodemographic disparities in the treatment of small renal masses

Abstract

To examine the presence of specific sociodemographic disparities in the treatment of individuals with small renal masses. Patients diagnosed with pT1aN0M0 renal cell carcinoma (RCC) were identified from the Surveillance, Epidemiology, and End Results database (years 1988-2008). Treatment type was stratified into non-surgical and surgical management and the group of patients who underwent surgical intervention was further stratified into those who underwent partial nephrectomy (PN) and those who underwent radical nephrectomy (RN). The main variables of interest were race and gender, as well as family income and poverty and education levels. Temporal trend analyses and logistic regression models were performed. Of 26,468 patients with T1aN0M0 RCC, 2797 (10.6%) were non-surgically managed and 23,671 (89.4%) underwent surgery. Of the latter, 14,705 (62.1%) underwent RN and 8966 (37.9%) PN. In multivariable analyses, black patients were 23% more likely to be non-surgically managed than other ethnic groups, and if surgically managed, were 20% less likely to undergo PN (both P ≤ 0.007). Men were 19% more likely than women to be non-surgically managed, but remained 14% more likely to receive a PN (both P < 0.001). Treatment disparities according to income, education and poverty level were recorded. Poverty (odds ratio [OR]: 1.002) and education (OR: 0.998) proxies emerged as important determinants of non-surgical management, whereas income (OR: 1.08, all P ≤ 0.02) was a determinant of PN. Social inequalities regarding access to treatment remain prevalent among patients diagnosed with small renal masses. The persistence of such a phenomenon is a concerning trend which merits further investigation.