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UPJ INSIGHT Impact of Socioeconomic Status on Patient Adherence in Managing Renal Masses

By: Alexander L. Sinks, BS, Wake Forest School of Medicine, Winston-Salem, North Carolina; Hailey W. Holck, BS, University of Texas Southwestern School of Medicine, Dallas; Lila G. McGrath, BS, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Laurel Zeng, MS, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Kris E. Gaston, MD, University of Texas Southwestern, Dallas; Stephen B. Riggs, MD, MBA, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Justin T. Matulay, MD, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Peter E. Clark, MD, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Ornob P. Roy, MD, MBA, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina | Posted on: 17 Jul 2024

Sinks AL, Holck HW, McGrath LG, et al. Impact of socioeconomic status on patient adherence in managing renal masses. Urol Pract. 2024;11(4):736-744. doi:10.1097/UPJ.0000000000000565

Study Need and Importance

Adherence to treatment plans and completion of required appointments are necessary for successful renal mass management. Although racial and socioeconomic status (SES) disparities have been previously documented in renal cell carcinoma patient treatment and outcomes, no study has expanded this investigation to patient adherence. We analyzed the relationship between both patient SES and race/ethnicity and adherence, nonadherence, and loss to follow-up.

What We Found

In a cohort of 1476 renal mass patients spanning from 2000 through 2020, 66.1% were adherent (completed all recommended appointments within 6 months of initial follow-up) and 10.7% were nonadherent (did not complete all recommended appointments within 6 months of initial follow-up but eventually did) to management protocols, while 23.2% were lost to follow-up. We found that lower SES and/or Black race were associated with decreased adherence, increased nonadherence, and loss to follow-up. Upon multivariate logistic regression, after adjustment for race/ethnicity, patients in higher Area Deprivation Index (ADI) quartiles (lower SES) and of lower income were less adherent (ADI P = .015, income P < .001; Figure) and more likely to be lost to follow-up (ADI P = .067, income P < .001).

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Figure. Adherence based on socioeconomic status. A, Adherence differed significantly by Area Deprivation Index (ADI) quartile (Q; P = .022) and was significantly associated with ADI Q (P = .015). B, Adherence significantly differed by income bracket (P < .001) and was associated with income bracket (P < .001). *Adjusted for race/ethnicity. OR indicates odds ratio.

Limitations

The study is retrospective and limited to a single-institution cohort. Measurements for SES including ADI, Census income, and insurance status were taken for one point in time.

Interpretation for Patient Care

Our findings indicate that patients of minority groups and of low SES as indicated by ADI and income are less adherent to renal mass management. Social determinants of health screening, nurse navigator programs, and financial assistance programs may help to provide resources to patients to improve care continuity and equity.

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