Racial and socioeconomic disparities from time of diagnosis to treatment for small renal masses.

Objectives: To investigate how patient-specific factors, including race and socioeconomic status, impact time to treatment initiation (TTI) for patients with small renal masses (SRMs). Materials and Methods: We retrospectively reviewed 275 patients with SRMs ≤ 4 cm at Atrium Health Carolinas Medical Center who underwent treatment for their renal mass. TTI was defined by the time between office visit (TTI-OV) or between initial imaging (TTI-Imaging) and procedure date. Statistical analysis was employed to determine patient-specific factors associated with TTI. Results: We found that TTI was significantly associated with race as Black patients experienced longer TTI than non-Hispanic White patients (OV: HR = 0.637, 95% CI [0.479-0.848], p = 0.0048; Imaging: HR = 0.541, 95% CI [0.402-0.727], p = 0.0002). TTI, however, was not significantly associated with socioeconomic status as defined by Area Deprivation Index, income or insurance status. TTI-OV was also significantly associated with procedure year, and TTI-Imaging was associated with procedure year, Charlson Comorbidity Index (CCI) and tumour size when first seen on imaging. On multivariable analysis, TTI-Imaging was not independently associated with race (p = 0.1775), suggesting procedure year, CCI and tumour size are more significant predictors of TTI. Conclusion: Black patients experienced a treatment delay from initial clinical presentation to procedure, but treatment delays from initial imaging identification to procedure may be tied more strongly to clinical factors.