Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Brian Shuch

Abstract

Introduction: Significant racial disparities in survival for renal cell carcinoma (RCC) exist between whites and blacks. 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.

Methods: As part of a case-control study within the Kaiser Permanente Northern California system, pathologic and clinical records were obtained for RCC cases (2,152 white, 293 black) diagnosed from 1998 to 2008. Patient demographics, comorbidities, tumor characteristics, and treatment status were compared between whites and blacks. Overall survival and disease specific survival (DSS) were calculated by the Kaplan-Meier method. A Cox proportion hazards model was used to estimate the independent associations of race, comorbidity, and clinico-pathologic variables with DSS.

Results: Compared to whites, blacks 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 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.

Conclusions: Within a single healthcare system, we observed differences in characteristics of black and white patients with RCC; 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.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/12/2019

Share

COinS