Disparities in overall and urothelial carcinoma specific mortality associated with healthcare insurance status

Objective: We investigated the association of insurance status with urothelial carcinoma (UC) mortality outcomes to further understand the relationship of socioeconomic status (SES) and UC disease outcomes. Materials and Methods: We performed an IRB approved, retrospective review of patients newly diagnosed with bladder UC in the years 2004 and 2005. Data were collected from January 2004 to September 2014 regarding insurance, demographics, operations, surgical pathology, and follow-up care. Insurance was characterized as lower SES and high SES based on election to utilize private vs. public sources as well as purchase of supplemental Medicare coverage. Results: A total of 213 patients were examined with a mean follow-up of 84 months. The high SES and lower SES insurance groups presented with similar disease stage (26% ≥ T2 in high SES insurance vs. 33%, P = 0.1) and grade (60% high-grade in high SES vs. 59%, P = 0.9). Significant differences were seen in one-year UC specific mortality (5% high SES insurance vs. 21%, P = 0.003) and five-year UC specific mortality (19% high SES insurance vs. 42%, P = 0.007). Upon multivariate analysis controlling for age, gender, Charlson comorbidity score, grade, stage, and metastatic disease on presentation, insurance type remained a significant risk factor for increased mortality from UC (HR = 2.6, P < 0.01). Kaplan-Meier analysis showed a persistence of lower survival with time. Conclusions: We found disparities in mortality from bladder cancer associated with source of insurance. This association persisted upon multivariate analysis as an independent risk factor for death from bladder UC.