Abstract C085: Intersectionality of neighborhood socioeconomic deprivation, race/ethnicity, and obesity in renal cell carcinoma disparities in Hispanics and American Indians in Arizona
Authors: Batai Ken , Asif Waheed , Wightman Patrick , Cruz Alejandro , Valencia Celina I. , Gachupin Francine C. , Hsu Chiu-Hsieh , Chipollini Juan , Lee Benjamin R. 
Published: January 2023

Abstract
Background: Hispanic Americans (HAs) and American Indians (AIs) in Arizona experience marked disparities in renal cell carcinoma (RCC) with a younger age at diagnosis, higher stage, and higher mortality rates compared to non-Hispanic Whites (NHWs). The underlying factors causing the disparities are still under investigation. This study explored relationships between neighborhood characteristics, race/ethnicity, and obesity in RCC patients. Methods: Medical records of patients who underwent RCC surgical treatment between 2010 and 2021 at Banner University Medical Center Tucson/University of Arizona were reviewed. Social Deprivation Index (SDI) score was calculated using American Community Survey data and linked to the zip code of patient’s residence. Logistic regression analysis was performed to assess associations of SDI, race/ethnicity, and BMI with RCC characteristics and perioperative outcomes. Results: A total of 379 patients (49.9% NHWs, 34.6% HAs, and 7.4% AIs) with SDI data were included in this study. They lived in 116 zip code areas (86 in NHWs, 49 in HAs, and 13 in AIs). 18 patients (4.7%) lived in the most common zip code area. 51.7% of zip codes had only one patient living in the area. HAs and AIs were more likely to have an earlier age of diagnosis and higher BMI and live in high SDI neighborhoods compared to NHWs. SDI were positively associated with BMI in the total dataset and HAs, but not in NHWs. HA ethnicity and high BMI were significantly associated with earlier age of diagnosis. HAs had increased odds of having clear cell RCC, but the association was not significant after adjusting for SDI. HAs had an increased odds of clear cell RCC only in patients living in high SDI neighborhoods (OR 3.33, 95% CI 1.00-11.07). In patients living in low SDI neighborhoods, HAs had increased odds of advanced stage (OR 2.52, 95% CI 1.17-5.45), but not in patients living high SDI neighborhoods (P-interaction=0.02). BMI≥35 was associated with advanced stage in NHWs (OR 3.08, 95% CI 1.14-8.35), but not in HAs (P-interaction=0.07). SDI was not associated with advanced stage. SDI was associated with high grade in NHWs (OR 3.08, 95% CI 1.14-8.35), but not in HAs (P-interaction=0.06). Next, we investigated impacts of obesity on perioperative outcomes adjusting for SDI. BMI≥35 was associated with a longer ischemia time (OR 3.41, 95% CI 1.06-11.2), and this association was stronger in patients living in low SDI than high SDI neighborhoods and in HAs than NHWs. HAs with BMI 30-35 had increased odds (OR 7.83, 954% CI 1.18-51.81) of a greater estimated blood loss during the surgery. Patients with BMI 25-30 had significantly increased odds (OR 6.95 95% CI 1.18-41.00) of longer hospital stay after surgery. A stronger association was observed in NHWs, and the association was not significant in HAs. Conclusion: This study revealed that SDI is an underlying factor of obesity in RCC patients. The relationships between SDI, race/ethnicity, and obesity are complex, and obesity is impacting racial/ethnic groups differently.
Citation Format: Ken Batai, Waheed Asif, Patrick Wightman, Alejandro Cruz, Celina I. Valencia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee. Intersectionality of neighborhood socioeconomic deprivation, race/ethnicity, and obesity in renal cell carcinoma disparities in Hispanics and American Indians in Arizona [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C085.