Sociodemographic disparities in the treatment of small renal masses.
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Sociodemographic disparities in the treatment of small renal masses. / Becker, Andreas; Roghmann, Florian; Trinh, Quoc-Dien; Hansen, Jens; Tian, Zhe; Shariat, Shahrokh F; Noldus, Joachim; Perrotte, Paul; Graefen, Markus; Karakiewicz, Pierre I; Sun, Maxine.
in: BJU INT, Jahrgang 111, Nr. 8, 8, 2013, S. 274-282.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Sociodemographic disparities in the treatment of small renal masses.
AU - Becker, Andreas
AU - Roghmann, Florian
AU - Trinh, Quoc-Dien
AU - Hansen, Jens
AU - Tian, Zhe
AU - Shariat, Shahrokh F
AU - Noldus, Joachim
AU - Perrotte, Paul
AU - Graefen, Markus
AU - Karakiewicz, Pierre I
AU - Sun, Maxine
N1 - © 2013 BJU International.
PY - 2013
Y1 - 2013
N2 - OBJECTIVE: To examine the presence of specific sociodemographic disparities in the treatment of individuals with small renal masses.PATIENTS AND METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
AB - OBJECTIVE: To examine the presence of specific sociodemographic disparities in the treatment of individuals with small renal masses.PATIENTS AND METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
KW - Adult
KW - Age Distribution
KW - Aged
KW - Aged, 80 and over
KW - Carcinoma, Renal Cell
KW - Combined Modality Therapy
KW - Continental Population Groups
KW - Disease Management
KW - Female
KW - Humans
KW - Kidney Neoplasms
KW - Male
KW - Middle Aged
KW - Morbidity
KW - Neoplasm Staging
KW - Prognosis
KW - Retrospective Studies
KW - SEER Program
KW - Sex Distribution
KW - Socioeconomic Factors
KW - Survival Rate
KW - United States
U2 - 10.1111/bju.12111
DO - 10.1111/bju.12111
M3 - SCORING: Journal article
C2 - 23714645
VL - 111
SP - 274
EP - 282
JO - BJU INT
JF - BJU INT
SN - 1464-4096
IS - 8
M1 - 8
ER -