title: Racial disparities in renal cell carcinoma: a single-payer healthcare experience.
abstract: Significant racial disparities in survival for renal cell carcinoma (RCC) exist between white and black patients. Differences in access to care and comorbidities are possible contributors. To investigate if racial disparities persist when controlling for access to care, we analyzed data from a single-payer healthcare system. As part of a case-control study within the Kaiser Permanente Northern California system, pathologic and clinical records were obtained for RCC cases (2152 white, 293 black) diagnosed from 1998 to 2008. Patient demographics, comorbidities, tumor characteristics, and treatment status were compared. Overall survival and disease-specific survival (DSS) were calculated by the Kaplan-Meier method. A Cox proportion hazards model estimated the independent associations of race, comorbidity, and clinicopathologic variables with DSS. We found that compared to white patients, black patients were diagnosed at a younger age (median 62 vs. 66 years, P < 0.001), were more likely to have papillary RCC (15% vs. 5.2%, P < 0.001), and had similar rates of surgical treatment (78.8% vs. 77.9%, P = 0.764). On multivariate analysis, advanced American Joint Committee on Cancer (AJCC) stage, lack of surgical treatment, larger tumor size, and higher grade were predictors of worse DSS. Race was not an independent predictor of survival. Therefore, we conclude that within a single healthcare system, differences in characteristics of black and white patients with RCC persist; black patients had different comorbidities, were younger, and had decreased tumor stage. However, unlike other series, race was not an independent predictor of DSS, suggesting that survival differences in large registries may result from barriers to healthcare access and/or comorbidity rather than disease biology.
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Abiodun
authors.initials: A
authors.lastname: Mafolasire
authors.affiliation: Yale Center for Analytical Sciences, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Cayce
authors.initials: C
authors.lastname: Nawaf
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Suarez-Sarmiento
authors.affiliation: Department of Epidemiology, Anderson Cancer Center, Houston, Texas.
authors.forename: Wong-Ho
authors.initials: WH
authors.lastname: Chow
authors.affiliation: Kaiser Permanente Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Kaiser Permanente Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
authors.forename: Douglas
authors.initials: D
authors.lastname: Corley
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Hofmann
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
authors.forename: Mark
authors.initials: M
authors.lastname: Purdue
authors.affiliation: Department of Pathology, Yale School of Medicine, Yale University, New Heaven, Connecticut.
authors.forename: Adebowale J
authors.initials: AJ
authors.lastname: Adeniran
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Brian
authors.initials: B
authors.lastname: Shuch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology / Q000208:ethnology; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018426:SEER Program; D016019:Survival Analysis
keywords: Health disparity; RCC; kidney cancer; outcome; survival