Abstract A044: Socioeconomic Disadvantage and Survival Outcomes After Radical Cystectomy for Urothelial Carcinoma of the Bladder: Examining the Area Deprivation Index in a Single-Institution Cohort
Authors: Doshi Chirag , Dadabhoy Anosh , Molina Luis , Mehta Sejal , Moghaddam Farshad , Wood Erika , Xia Leilei , Djaladat Hooman , Schuckman Anne , Daneshmand Siamak 
Published: September 2024

Abstract
Introduction: To study the performance of a commonly used community-level measure of social determinants of health (SDoH) in national and state databases, the Area Deprivation Index (ADI), at measuring disparities in cancer survival in a single-institution cohort of urothelial carcinoma of the bladder (UCB) patients after radical cystectomy (RC). Methods: We queried our IRB-approved institutional database for patients receiving radical cystectomy with diversion from 2013 to 2019. ADI values already linked to 9-digit zip codes based on the crosswalk method of census block association were obtained and assigned to our population in quartiles(Q4&gt;Q1 in deprivation). Patients without associated ADI values were excluded. Multivariable logistic regression and Cox models were fit to assess the relationship between ADI and OS and RFS when adjusting for age, race, sex, stage, node status, smoking, diabetes. Kaplan-Meier (KM) curves were generated for OS and RFS. Results: Of the 726 patients identified, 81% were male with a median age of 71 years (Range: 35 – 93) at the time of cystectomy. The ages were found to be similar across all groups stratified by ADI quartiles. Of the 726 patients in our cohort, 83% percent identified as Non-Hispanic White. When comparing races by ADI quartiles, there was no significant difference when evaluating Non-Hispanic Whites against all Non-White participants (p = 0.24). Smoking, worse pathological staging, and evidence of lymphovascular invasion increased with higher ADI quartiles (p&lt;0.01). KM was significant for RFS (p= 0.0347) and OS (p= 0.0039). Factors predictive of worse survival on MVA were extravesical disease, node positive status, and lymphovascular invasion (p&lt;0.0001). Additionally, non-white race (p=0.01), and receipt of adjuvant chemotherapy (p=0.0371) were protective factors of overall survival. Increasing age was correlated with worse OS only(p= 0.0012). On MVA, ADI did not correlate with OS or RFS (p= 0.0633 and 0.2154). Conclusion: ADI, while previously shown to predict survival after RC in UCB, was not significantly correlated in our cohort. Contributing factors could be due to cohort selection (muscle-invasive vs. both), differences in data quality (single-institution vs state/national), or cohort size. Differences in regional demographics and how they are weighted may also contribute to nonsignificance. Further investigations into ADI, its state-specific measure, and individual SDoH components are warranted to better understand neighborhood factors that correlate with poor survival in UCB, as well as additional studies with a larger cohort.
Citation Format: Chirag Doshi, Anosh Dadabhoy, Luis Molina, Sejal Mehta, Farshad Moghaddam, Erika Wood, Leilei Xia, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand. Socioeconomic Disadvantage and Survival Outcomes After Radical Cystectomy for Urothelial Carcinoma of the Bladder: Examining the Area Deprivation Index in a Single-Institution Cohort [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A044.