Login to Access Video or Poster Abstract: MP10-01
Sources of Funding: None

Introduction

Bladder cancer (BC) continues to exact high morbidity and mortality in patients who have a history of tobacco use. Less is known about non-tobacco related factors associated with BC-related death which may be targeted to lower the incidence or course of the disease. The mortality-to-incidence ratio (MIR) is a novel measure that has utility as a valid indicator of fatality and burden of disease. We hypothesized that a pooled county-level, population-based dataset from the United States, could demonstrate smoking and non-smoking related risk factors that may be modifiable targets in a prevention strategy.

Methods

Surveillance Epidemiology and End Results (SEER) population-based cancer registry data; state-specific Behavioral Risk Factor Surveillance Study (BRFSS) results; health care manpower, psychosocial, and socio-economic data from the 2014-2015 Area Health Resources File (AHRF) were pooled to establish independent variables associated with the MIR of BC by county. Cancer data was suppressed to ensure confidentiality and stability of rate estimates. Independent multivariate stepwise regression models were built for either sex.

Results

A total of 3140 counties in the U.S. were included in the dataset, of which 666 and 265 counties had complete data for males and females, respectively. The mean (+/- sd) MIR of BC was 0.22 (0.05) and 0.26 (0.07) for males and females, respectively (range: 0.11 - 0.77). Tobacco was strongly associated with the MIR of bladder cancer in all counties. On multivariate analysis, significant non-tobacco-related factors that predicted a greater MIR of BC in males were: poverty, lack of insurance, low urologist density; in females: poverty, obesity and low urologist density.

Conclusions

There is an independent association with death from bladder cancer due to inadequate access to healthcare, including urologists, and risk factors such as obesity and poverty, especially in women. Our study demonstrates that bladder cancer continues to afflict the poor, especially those who smoke and who have little access to health care (Figure 1). Prevention strategies may be more effective if anti-smoking campaigns target medically (and urologically) underserved, rural, and obese populations. The MIR is a novel indicator of the effectiveness of the health system.

Funding

None