Impact of Socioeconomic Status on Patient Adherence in Managing Renal Masses

• Published in: Urology practice Vol. 11; no. 4; p. 736
• Main Authors: Sinks, Alexander L, Holck, Hailey W, McGrath, Lila G, Zeng, Laurel, Gaston, Kris E, Riggs, Stephen B, Matulay, Justin T, Clark, Peter E, Roy, Ornob P
• Format: Journal Article
• Language: English
• Published: United States 01.07.2024
• Subjects: Aged; Female; Humans; Kidney Neoplasms - economics; Kidney Neoplasms - ethnology; Kidney Neoplasms - therapy; Male; Middle Aged; Patient Compliance - ethnology; Patient Compliance - statistics & numerical data; Retrospective Studies; Social Class; lost to follow-up; patient adherence; renal cell carcinoma; socioeconomic status
• ISSN: 2352-0787; 2352-0787
• DOI: 10.1097/UPJ.0000000000000565

Previous literature suggests socioeconomic status and racial disparities impact management decisions for patients with small renal masses. We aim to build upon these findings and examine how these modalities impact patient adherence to their management plan. This retrospective study analyzed our Kidney Tumor Program database (n = 1476) containing patients from 2000 to 2020. Socioeconomic status was estimated using 2 modalities: Area Deprivation Index and household income. Patients were then evaluated for differences in adherence, nonadherence, and loss to follow-up. Adherent patients completed all recommended appointments within 6 months of their initial follow-up. Nonadherent patients did not complete all recommended appointments within 6 months of their originally scheduled follow-up but eventually did. Patients lost to follow-up were recommended to follow up but never did. Patient adherence was not significantly different across sex or primary treatment method but differed with respect to race/ethnicity. Black patients were significantly more likely to be nonadherent ( = .021) and lost to follow-up ( = .008). After adjusting for race/ethnicity, Area Deprivation Index and income bracket were significantly associated with adherence and loss to follow-up. Patients with a high socioeconomic status had significantly higher rates of adherence (ADI, quartile [Q] 1 vs Q4, = .038; income, >$120,000 vs $30,000-$59,999, < .003) and decreased loss to follow-up (ADI, Q1 vs Q4, = .03; income, >$120,000 vs $30,000-$59,999, = .002). Our results demonstrate that Black race and low socioeconomic status are associated with decreased adherence and increased loss to follow-up. Possible strategies to target these disparities include financial assistance programming, social determinants of health screening, and nurse navigator programs.