Understanding health inequalities based on socio-economic factors and geographical location in renal cell carcinoma: A large-scale national cohort study in England.

Abstract

464 Background: Kidney cancer is 7 th most common cancer in England with renal cell carcinoma (RCC) accounting for about 80% of all cases of kidney cancer. It has well established that the incidence and mortality rates of RCC are strongly associated with four main risk factors, including family history, lifestyle, environment, and occupation. In addition, unequal access to improvements in RCC cancer treatment and limited access to screening and diagnosis, significantly contribute to the difference observed in survival rate. Methods: We aim to assess the association between area-level measures of socioeconomic deprivation, from the 20% most deprived of the population (quintile 1) to the 20% least deprived (quintile 5), or geographical regions in England, with both the diagnosis and treatment of RCC, over five years from April 2019 to March 2024. This study utilized patient-level data for primary and metastatic renal cancer (ICD-10: C64) by organisation, procedure, ethnicity, age group and deprivation quintile from Hospital Episode Statistics (HES). Results: Among 54,535 included patients, 9,935 (18.2%) came from the most deprived quintile and 11,330 (20.8%) from the least deprived quintile with a mean age of 62 years across all patients. Of included patients, 43,290 (79.3%) were Caucasian (white) and the remaining 14,235 patients came from other ethnic groups. In total, 61.0% of patients were middle aged (aged from 45 to 74), with 35.0% elderly (75 and above) and 5.4% classed as young (below 45). Caucasian populations have higher rates of metastatic disease (34.6%) vs non white (29.6%). Prevalence of metastatic disease increases with age (24.1% vs 33.3% vs 34.6% in young, middle aged and elderly respectively). Higher deprivation is associated with lower rates of nephrectomy (42.3% in most deprived vs 43.6% in least deprived). Patients in areas of higher deprivation are on average younger than those in least deprived areas (57 years in most deprived vs 64 in least deprived) while non-white renal cancer patients are also typically younger (57 non-white vs 64 white). The Midlands (central England) region is associated with the highest rates of metastatic cancer (37.4%) while North East & Yorkshire (30.8%) and London (31.1%) has the lowest metastatic disease rates. Conversely, total nephrectomy rates are highest in North East & Yorkshire while they are lowest in the South West region and London (46.6% vs 42.8% vs 43.0% respectively). Conclusions: This study presents the most recent and extensive RCC data from England, exploring the impact of socioeconomic status and geographical location in diagnosis and management of RCC. These findings could facilitate targeted initiatives to improve health inequity across regions in England.