Neighborhood Socioeconomic Disadvantage Associated With Increased 90-Day Mortality Following Radical Cystectomy

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Radical cystectomy (RC) is a major surgery for bladder cancer.
• Neighborhood socioeconomic status may influence health outcomes.
• The impact of socioeconomic disadvantage on RC outcomes requires investigation.

Purpose of the Study:

• To investigate the association between neighborhood socioeconomic disadvantage and outcomes after radical cystectomy (RC).

Main Methods:

• Retrospective study of 906 patients undergoing RC for bladder cancer (2011-2019).
• Outcomes analyzed included major complications, mortality, and survival.
• Statistical analyses used Cochran-Armitage, Kruskal-Wallis, and Cox proportional hazards models.
• Area Deprivation Index (ADI) was used to quantify socioeconomic disadvantage.

Main Results:

• Higher ADI quartiles were associated with increased 90-day mortality (0% in lowest vs. 6.5% in highest).
• Patients in the most disadvantaged quartile had worse overall and recurrence-free survival.
• ADI was linked to higher rates of muscle-invasive and node-positive bladder cancer.
• ADI percentile independently predicted 90-day mortality (aOR 1.022).

Conclusions:

• Socioeconomic disadvantage, measured by ADI, is associated with poorer outcomes following radical cystectomy.
• Higher disadvantage correlates with increased mortality and worse oncologic results.
• ADI can aid in patient counseling, risk stratification, and post-discharge care planning for RC patients.