Social Determinants Contribute to Disparities in Test Positivity, Morbidity and Mortality: Data from a Multi-Ethnic Cohort of 1094 GU Cancer Patients Undergoing Assessment for COVID-19

Round 1

Reviewer 1 Report

Authors should be congratulated for the great work. The topic is interesting and challenging. During the SARS COV2 pandemic outbreak, existing inequalities in the social determinants of health have influenced disease burden and access to healthcare. The manuscript is well-written and easily readable, the methodology is robust, and tables are clear. Nevertheless, several points warrant a mention:

·      The manuscript need a moderate grammar revision;

·      Authors must make corrections to abbreviations, sometimes reported without having previously described them;

·      It would be interesting if the authors focused attention on these papers which highlighted differences in terms of mortality linked to genitourinary neoplasms of rural populations vs urban populations, in the pre-COVID 19 era. (PMID: 33709970); (PMID: 33230694); (PMID: 33155063).

Author Response

Many thanks to Review 1 for their kind comments and constructive feedback.

The manuscript has been reassessed and the grammar errors have been corrected.

The abbreviations have also been corrected.

The introduction has been improved to discuss GU cancer mortality rates from rural and urban populations and the appropriate papers have been cited, as recommended.

Reviewer 2 Report

Thank you for the opportunity to assess your research. This is an important data, but it does not have a lot of novelty. It has been long known that SDOH is associated with various outcomes in most fields. This study is limitted to GU malignanciy with COVID-19. Not most readers of "reports" will not have interest on your research. The outcome is only intubation and mortality, and the number of intubation is limitted in your research to conclude the result. It is desirable to state about Post Intensive Care Syndrome (PICS), which is often more important than intubation and mortality. Especially, in your artilce, you mention about intubation and mortality, which is generally concered in critically ill patients. I think following review article is beneficial to learn about PICS after COVID-19 (PMID: 34501316 DOI: 10.3390/jcm10173870). It is desirable to use data about PICS including physical functgion, mental disorder, and cognitive disorders. At the very least, you need to discuss about PICS in background or discussion if your article discuss about the outcome for patients.

Author Response

Although this paper was limited to GU cancers, we feel it is still of great interest to the readers of this journal. Prostate cancer is the commonest non cutaneous malignancy in men, and prostate adenocarcinoma cells may have the highest TMPRSS2 expression of all cancers, thus highlighting the need to investigate the relationship between GU cancers and COVID-19. The reviewer does raise an interesting point of the outcomes for these patients relateive to PICS. Unfortunately, this data is deidentified, and as such we do not have any long term follow up of these patients as yet. However we have added the above reference to the manuscript and mentioned this as a limitation of the study.

Round 2

Reviewer 1 Report

Authors should be congratulated for the great work. The topic is interesting and challenging. During the SARS COV2 pandemic outbreak, existing inequalities in the social determinants of health have influenced disease burden and access to healthcare. The manuscript is well-written and easily readable, the methodology is robust, and tables are clear. Authors improved the quality of the manuscript. Now,the manuscript is suitable for publication in current form

Reviewer 2 Report

Thank you for the opportunitiy to review your paper. Authors responded to all necessary queries kindly and properly. I think this paper is worth accepting. Congratulation!