Disparities in health care are well documented; however, their prevalence in the field of urology continues to be defined. Studies of prostate cancer have indicated differential treatments and outcomes in minority groups, and disparities in the treatment of renal masses continue to emerge.[1, 2] Chow et al recently examined survival outcomes for renal cell carcinoma using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, demonstrating that although black patients present more frequently with localized disease and at a younger age, they have worse survival even when stratifying by sex, age, tumor stage, tumor size, histologic subtype, and type of surgical treatment. Furthermore, this gap appears to be widening over time, with the largest disparity noted in the most recent era. Chow et al conclude that although white patients with renal cell carcinoma have a survival advantage over black patients in nearly all categories evaluated, the underlying mechanisms have not been described. We applaud their efforts to bring this important observation to the forefront of medical thought, especially as we undergo a tumultuous overhaul of the medical system aimed in part at reducing differential health outcomes. Their article provides an important foundation for further examination into disparities, as well as demonstrates the need to take a deeper look beyond the characteristics of black and white race and gender. Indeed, recent examinations into urologic oncology procedures indicate that income/socioeconomic status, insurance type, and access to care may play just as an important role as race.[3, 4] Furthermore, as the genomics era flourishes, we are gaining insights that indicate that differences in race may have less to do with the genomic and molecular underpinnings of disease than once thought, with genetic variations demonstrating a higher prevalence within racial and ethnic groups than between groups. Taken together, these findings indicate that race itself may not be the underlying cause of differential outcomes, but instead may be a marker of environmental, situational, and other nonbiologic factors, as well as a continued differential in interpersonal interactions. As the field moves forward in the important examination of health care disparities, a more complex examination of interacting factors, as initiated by Chow et al, will be needed to identify those areas in which future interventions can have the most impact to improve the health of all patients.
CONFLICT OF INTEREST DISCLOSURES
The authors made no disclosures.
Manuel S. Eisenberg, MD
Urologic Oncology Fellow
Department of Urology, Mayo Clinic, Rochester
Bradley C. Leibovich, MD
Chief of Urologic Oncology, Department of Urology, Mayo Clinic, Rochester
Simon P. Kim, MD
Urologic Oncology Fellow, Department of Urology, Mayo Clinic, Rochester