Introduction:

We aimed to determine the effects of Neighborhood Deprivation (ND) on bladder cancer (UBC) survival by using a state-specific neighborhood deprivation index (the Healthy Places Index, HPI) in measuring recurrence-free survival (RFS) and overall-survival (OS).

Methods:

We queried our prospectively-maintained IRB-approved MIBC database (#HS-01B014) at the University of Southern California (USC) for patients receiving radical cystectomy for curative intent with diversion from 2013 to 2019. Demographic, Clinicopathologic, and survival data was obtained. HPI values were linked to 5-digit zip codes via the crosswalk method of census block association and assigned to our population in quartiles with Q1 being the most deprived. Multivariable (MVA) logistic regression and Cox models were fit to assess the relationship between HPI and OS and RFS when adjusting for age, race, sex, stage, node status, smoking, and diabetes. Kaplan-Meier (KM) curves were generated for OS and RFS.

Results:

729 patients were included for analysis. Within the cohort, non-white patients (8.92%) who were associated with more ND (p<0.001). (Table 1) On MVA, age (HR 1.02 95% CI: 1.01-1.04, p=0.003), extravesical disease (HR 2.61 95% CI: 1.78-3.82, p <0.001), node-positive status (HR 2.95 95% CI: 2.00-4.34, p<0.001), lymphovascular invasion (HR 2.01 95% CI: 1.43-2.80, p<0.001), and worse ND measured by HPI (HR 1.76 95% CI: 1.18-2.62, p = 0.01) were associated with worse OS. Non-white race was associated with better OS (HR 0.499 p = 0.002). Older age, male gender, and comparing the most deprived quartile to the least were significant predictors of pathologic staging >T2, extravesicular cancer, and lymphovascular invasion (HR: 2.32, 95% CI: 1.48 - 3.65, p<0.001).

Conclusion:

More neighborhood deprivation is correlated with worse OS in UBC. Black and non-white Hispanic patients receiving surgery for UBC experienced a higher proportion of deprivation, but non-white race is correlated with better OS in UBC. Higher powered studies are required to confidently identify disparities in care for non-white patients experiencing UBC.

Funding: N/A