Introduction: Radical cystectomy with pelvic lymphadenectomy is one of the primary modalities for the treatment of muscle invasive bladder cancer. Many studies have shown that insurance status acts as a prognostic indicator in cancer survivorship. Therefore, evaluating the interplay between insurance status and cancer prognosis following a radical cystectomy holds broad relevance for disadvantaged populations who are either uninsured or underinsured.
Methods: This retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results (SEER) national database from 2007 to 2015 to assess whether insurance status was associated with improved overall and bladder cause-specific survival in 3,057 patients with muscle invasive bladder cancer undergoing a radical cystectomy. Patients were categorized based on insurance type: non-Medicaid, Medicaid, and uninsured. Pearson’s chi-square test assessed the distribution of demographic factors, tumor characteristics, and surgical variables across the insurance groups. Overall and bladder cause-specific survival were estimated using a Kaplan-Meier survival analysis and a multivariate Cox hazards proportional model analysis.
Results: Mean overall survival (p < .001) and bladder cancer-specific survival (p = .002) times significantly differed between insurance status groups according to the Kaplan-Meier curve log-rank test. Multivariable Cox hazards proportional model showed that, compared to non-Medicaid insured patients, Medicaid patients had an increased risk of overall death (hazard ratio [HR]=1.19, 95% CI=1.01-1.41), and uninsured patients had an increased risk of death from any cause (HR=1.33, 95% CI=1.08-1.64). For bladder cause-specific mortality, uninsured patients had an increased risk of death compared to non-Medicaid patients (HR=1.36, 95% CI=1.08-1.70).
Conclusions: Overall, Medicaid does not fully reduce the differences caused by social determinants of health for overall survival but appears to mitigate bladder cause-specific mortality. The intersection between health and social determinants of health is complex thus insurance alone cannot bridge the gap in health disparities. Insurance may act as an indicator for cancer prognosis and should be considered in the clinical assessment of bladder cancer patients receiving a radical cystectomy. Additional strategies to maximize health care assess for bladder cancer patients must be developed.
.jpg)
.jpg)