Socioeconomic Determinants of Racial Disparities in Survival Outcomes Among Patients with Renal Cell Carcinoma

Race-specific outcomes in healthcare are challenging to study by virtue of their multifactorial complexity. Aside from inherent, biologically driven differences that may exist among races, socioeconomic disparities impacting access to care and cultural differences influencing trust in the healthcare system at large also play significant roles in driving discrepant outcomes.

This racially biased phenomenon is particularly evident within oncology, as adequate access to resources and multidisciplinary care teams is paramount to public awareness and education, early detection of disease, prompt initiation of treatment, and appropriate longitudinal follow-up.

Heretofore, studies evaluating the impact of race on renal cell carcinoma (RCC) outcomes have been inconsistent. These clinical studies are limited in their ability to disentangle socioeconomic factors from true biological differences influencing outcomes by race.

In this study, we used a national, population-based cancer registry (the National Cancer Database) to comprehensively analyze multiple socioeconomic determinants of racial disparities in survival outcomes among nearly 400,000 patients with renal cell carcinoma (RCC). We analyzed all comers and performed additional subanalyses matched by stage (including non-metastatic small renal masses and metastatic patients) and histologic subtypes (clear cell RCC and papillary RCC). Overall, we found that Black patients with RCC exhibit worse survival outcomes compared to White patients across all stages and histologies. Interestingly, this is despite the observation that Black patients are diagnosed at a relatively earlier stage.

We showed that socioeconomic disparities, which disproportionately affect Black patients, play an important role in impacting survival in RCC. They likely drive inequalities in access to care and are magnified in locally advanced or metastatic cases that would benefit from multidisciplinary expertise.

We propose that targeting these social factors accounting for non-biological discrepancies in survival and improving public health awareness and access among underrepresented minority groups may help close the racial gap in RCC outcomes across the entire spectrum of disease.

In separate ongoing work, we are elucidating the molecular differences in disease biology underpinning RCC outcomes by genetic ancestry. These exciting investigations will be important to complement the clinical and socioeconomic observations described herein.

Written by: Nirmish Singla, MD, MSCS, Associate Professor, Departments of Urology and Oncology, The James Buchanan Brady, Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD

Read the Abstract

Login