Abstract A043: Improving our understanding of social determinants of health and neighborhood deprivation on survival in patients after radical cystectomy for urothelial carcinoma
Authors: Dadabhoy Anosh , Doshi Chirag , Mehta Sejal , Moghaddam Farshad Sheybaee , Molina Luis Santos , Wood Erika , Xia Leilei , Djaladat Hooman , Schuckman Anne , Daneshmand Siamak 
Published: September 2024

Abstract
Introduction: To determine the effects of Social Determinants of Health (SDoH) represented by neighborhood deprivation (ND) and ethnicity on bladder cancer 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 IRB-approved institutional database for patients receiving radical cystectomy with diversion from 2013 to 2019. HPI values already linked to 5-digit zip codes via crosswalk method of census block association were obtained and assigned to our population in quartiles(Q1 representing most deprivation). Patients without associated HPI values were excluded. 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, diabetes. Kaplan-meier(KM) curves were generated for OS and RFS. Results: 729 patients were included for analysis, of which 81% were male with a median age of 71 years (Range: 35 – 93) at the time of cystectomy. No differences were seen between quartiles for age. 82.99% were non-hispanic white and ethnic minorities comprising 17.01% of patients. Non-white patients were associated with more ND (Q1 41.94%, Q2 29.03%, Q3 16.94%, Q4 12.10%, p&lt;000.1). There were 65 (8.92%) non-white hispanic and black patients (Q1 56.92%, Q2 23.08%, Q3 13.85%, Q4 6.15%, p&lt;0.0001). On MVA Age (HR 95% 1.024 p=0.0026), extravesical disease (HR 95% 2.605 p &lt;0.0001), Node positive status (HR 95% 2.948 p&lt;0.0001), lymphovascular invasion (HR 95% 2.005 p&lt;0.0001), and worse ND measured by HPI (Q4 vs Q1 HR 95% 1.759 p = 0.0055) were associated with worse overall survival(OS). Non-white race was associated with better OS (HR 95% 0.499 p = 0.0017) and RFS (HR 95% 0.581 p=0.0108). Kaplan-Meier demonstrated worse recurrence-free survival p=0.0118 and OS p=0.0109 for the most deprived quartile(Q1). 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. Additionally, analysis of individual SDoH included in the HPI is merited to investigate a more specific correlation with UBC.
Citation Format: Anosh Dadabhoy, Chirag Doshi, Sejal Mehta, Farshad Sheybaee Moghaddam, Luis Santos Molina, Erika Wood, Leilei Xia, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand. Improving our understanding of social determinants of health and neighborhood deprivation on survival in patients after radical cystectomy for urothelial carcinoma [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 A043.