Login to Access Video or Poster Abstract: MP10-14
Sources of Funding: none

Introduction

Bladder cancer is the most expensive cancer to manage from diagnosis to death. We used a nationwide cohort to evaluate sociodemographic disparities in the presentation of late stage bladder cancer and patient overall survival.

Methods

We analyzed all patients diagnosed with urothelial carcinoma of the bladder in the National Cancer Data Base from 2004 to 2013. A four level measure of socioeconomic status (SES) was developed by combining data on patient Zip Code median household income and high school education rates. Using multivariable logistic regression analysis, we assessed the association between SES, insurance (Private or Medicare vs no insurance or Medicaid), sex, and race (White, Black, Hispanic) with the diagnosis of late stage bladder cancer (stages III or IV). Cox proportional, Kaplan Meier, and log rank analyses were utilized to assess the association between covariates and overall survival.

Results

Of our final cohort of 328,569 patients, 25,046 (7.6%) were diagnosed with late stage bladder cancer. From highest to lowest SES, odds of late stage increased continuously (adjusted odds ratio [OR]: highest vs second 1.15, vs third 1.34, vs lowest 1.45). White males had the lowest odds of late stage diagnoses while Black females had the highest odds of late stage diagnoses compared to White males (adjusted OR 2.06, 95% CI 2.06, P<0.001). Females had higher rates of late state diagnoses compared to their male racial counterparts. Insurance type did not affect late stage diagnoses (adjusted p=0.05). Median overall survival for patients with late stage bladder cancer was 12 months for patients in the highest SES and 10 months for patients in the lowest SES (log rank p<0.001 and adjusted HR 1.14, 95% CI 1.08-1.21, p<0.001). Compared to patients in the highest SES, patients in the lowest SES received chemotherapy about as often (20%), were more likely to be treated at a community hospital (14% vs 9%, p<0.001), and more likely to delay radical cystectomy greater than 8 weeks following diagnosis (16% vs 12%, p<0.001).

Conclusions

Lower SES was associated with increased odds of late stage bladder cancer diagnoses and worse survival among patients with late stage disease. Insurance status did not alter stage at diagnosis when adjusting for SES. This implies expanding insurance coverage for patients will not completely mitigate disparities in bladder cancer outcomes. Black females are most likely to be diagnosed with late stage bladder cancer.

Funding

none