Prognosis impact and clinical findings in renal cancer patients: comparative analysis between public and private health coverage in a cross-sectional and multicenter context

TL;DR

This study found that patients with public health coverage in Mexico tend to be diagnosed with larger and more advanced kidney tumors compared to those with private coverage.

Contribution

The study provides new evidence on healthcare disparities in renal cancer diagnosis between public and private sectors in a developing country context.

Findings

Public sector patients had tumors 1.9 cm larger on average than private sector patients.

Public coverage was associated with more advanced disease and fewer minimally invasive surgeries.

A male-to-female ratio of 2.6:1 was observed in the private coverage group.

Abstract

Research on disparities in prognosis and clinical characteristics between public and private healthcare sectors in developing countries remains limited. The study aimed to determine whether patients with public health coverage (1) have a greater mean tumor size at diagnosis compared to those with private health coverage; (2) exhibit differences in clinical staging and TNM classification between groups; and (3) show variations in demographic, clinical characteristics, histopathological findings, and surgical approaches among cohorts.

A cross-sectional, multicenter study was conducted on 629 patients from both private and public healthcare sectors, all histologically confirmed and surgically treated for Renal Cell Carcinoma (RCC), between 2011 and 2021 in high-volume hospitals in Monterrey, Mexico. To compare variables between groups, we employed independent samples t-tests, Mann Whitney U nonparametric test, along with Pearson’s chi-square test complemented by post hoc analyses.

Mean tumor size in the public group was 1.9 cm greater than in the private group (7.39 vs. 5.51 cm, p < 0.001). Patients in the public sector more frequently presented with larger tumors, a higher prevalence of risk factors (excluding BMI and hypertension), advanced disease (OR 2.12, 95% CI 1.43–3.16, p < 0.001), presence of symptoms, elevated TNM, lymphovascular invasion and a lower prevalence of minimally invasive surgery. A male-to-female ratio of 2.6:1 was noted in the private coverage group.

This study highlights a notable association between public health coverage and a higher prevalence of advanced RCC, with tumors in private coverage patients being smaller yet larger than commonly reported. There is a crucial need to develop new health policies for early detection of renal cancer in developing countries.

The online version contains supplementary material available at 10.1007/s10552-024-01891-3.

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