title: Socioeconomic status is associated with urinary diversion utilization after radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  To assess socioeconomic disparities in urinary diversion utilization in a contemporary American cohort.
  
  
  METHODS
  In the National Cancer Database, we identified 4538 patients who underwent cystectomy with urinary diversion for clinical T1-2N0M0 bladder cancer from 2010 to 2013. Multivariable logistic regression was used to identify predictors of urinary diversion type: ileal conduit (IC), continent cutaneous reservoir (CCR), or orthotopic neobladder (ON). Covariates included age, gender, race, income, Charlson score, clinical T stage, hospital cystectomy volume, teaching status, and surgical approach. Subgroup analysis by hospital volume (low, intermediate, or high) and teaching status (academic or non-academic) was performed to ascertain the impact of regionalization on urinary diversion use.
  
  
  RESULTS
  The final cohort included 4066 (89.6 %) patients with IC, 292 (6.4 %) with CCR, and 180 (4.0 %) with ON. On multivariable analysis, younger age (p < .01), higher income (p < .01), and high cystectomy volume predicted increased use of CCR and ON. Female gender predicted increased use of CCR versus IC (p < .01), and academic hospital status predicted increased use of ON versus IC (p = .04). On subgroup analysis, after further adjustment for hospital volume and teaching status, higher income remained an independent predictor of ON use.
  
  
  CONCLUSIONS
  Despite regionalization of care, higher income patients are more likely to receive complex urinary diversions after radical cystectomy. Other related socioeconomic factors, especially patient education, may influence this practice pattern.
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Maurice
authors.affiliation: Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Office 4565, Mailstop LKS 5046, Cleveland, OH, 44106, USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Office 4565, Mailstop LKS 5046, Cleveland, OH, 44106, USA. robert.abouassaly@uhhospitals.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D012923:Social Class; D019738:Surgically-Created Structures; D014481:United States; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods / Q000706:statistics & numerical data*
keywords: Income; Social class; Urinary diversion