(UroToday.com) Danny Long & Colleagues evaluate the impact of race (as a social construct) on the receipt of radical cystectomy within the VA Healthcare system. As the authors note, the Veterans Affairs Health System is the large equal access health care system in the United States. As such, much (but not all) of the impact of socioeconomic status on healthcare delivery is mitigated. They chose to use this system to evaluate the receipt of radical cystectomy (RC) for patients with muscle invasive bladder cancer (MIBC), as it is guideline recommended treatment.
This was a retrospective study using the VA Health care system. They identified a total of 6,883 Veterans diagnosed with MIBC from January 1, 2000, to December 31, 2020. Patients were excluded if they were exposed to agent orange during service or had missing race. The primary outcome was receipt of RC (yes vs. no). Univariable and multivariable logistic regression models were used to test the association between race (White, Black, Other) and RC receipt. Multivariable models were adjusted for age at BC diagnosis, year of BC diagnosis, year of Veterans Affairs (VA) entry, gender, poverty status (determined by zip code), branch of service, Charlson comorbidity index (CCI), smoking history, and body mass index (BMI).
- However, there was no accounting for other socioeconomic factors, such as homelessness.
- Race was a construct of the classification, with little room for nuanced racial identify
Of the 5,179 patients who met inclusion criteria, only 1,426 (27.5%) received RC. Race was associated with RC in both univariable (p=0.009) and multivariable (p=0.037) analyses. In multivariable analysis, Blacks were less likely to undergo RC than Whites, though this relationship did not reach significance (OR: 0.91; 95% CI: 0.74-1.12). Other races were significantly less likely to undergo RC than Whites (OR: 0.58; 95% CI: 0.38-0.90).
Other variables significantly associated with RC in multivariable analysis were age (OR: 0.96; 95% CI: 0.95-0.97) and CCI (OR 3+ vs. 0: 0.46; 95% CI: 0.38-0.55).
Based on this, the authors note that in one of the largest RC cohorts studied in the largest equal access setting in the US, there was no significant difference in RC use among Blacks compared to Whites. However, they did observe significantly decreased RC use among other races than Whites.
Presented by: Danny Long, Application Developer, Institute for Medical Research
Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Associate Professor of Urology, University of California, Davis @tchandra_uromd @UCDavisUrology on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023