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Sources of Funding: None

Introduction

Herein, we examined the California Cancer Registry (CCR) to determine bladder cancer survival disparities based on race, socioeconomic status (SES), insurance type, and tumor histopathology in California patients.

Methods

The CCR was queried for bladder cancer cases in California from 1988 - 2012. Survival analyses were performed to determine the prognostic significance of racial and socioeconomic factors. Disease specific survival (DSS) of patients with squamous cell carcinoma (SCC) was compared to urothelial carcinoma (UCB).

Results

72,452 cases were included (75% men, 25% women). Median age was 72 (range 18 - 109). 81% were white, 3.8% black, 8.8% Hispanic, 5.2% Asian, and 1.2% others. SES was stratified by quintile. In black patients, tumors presented more frequently with non-urothelial histology, advanced stage, and high-grade and in females. Medicaid patients tended to be younger and have more advanced stage and high-grade tumors compared to those with Medicare or managed care (p < 0.0001). Kaplan-Meier analyses demonstrated significantly poorer 5-year DSS in black, low SES, Medicaid patients and in SCC compared to UCB (p < 0.0001). Multivariate analysis revealed that black race (DSS HR 1.295, 95% CI: 1.212 - 1.384), lowest SES (DSS HR 1.325, 95% CI: 1.259 - 1.395), Medicaid insurance (DSS HR 1.349, 95% CI: 1.246 - 1.460), and SCC histology (DSS HR 2.617 95% CI: 2.434 - 2.814) were all independent prognostic factors (all p < 0.0001) after controlling for stage, grade, age, and gender.

Conclusions

Analysis of California Cancer Registry demonstrated that black ethnicity, low SES, Medicaid insurance and squamous cell histology portend poorer disease-specific survival for bladder cancer patients in California, after adjusting for classic clinicopathological features.

Funding

None