Racial disparities in stage at bladder cancer diagnosis in the US Veterans Affairs healthcare system

Kelly K Bree; Jessica L Janes; Patrick J Hensley; Aditya Srinivasan; Amanda M De Hoedt; Sanjay Das; Stephen J Freedland; Stephen B Williams

doi:10.1111/bju.16380

Racial disparities in stage at bladder cancer diagnosis in the US Veterans Affairs healthcare system

BJU Int. 2024 Apr 29. doi: 10.1111/bju.16380. Online ahead of print.

Authors

Kelly K Bree¹, Jessica L Janes², Patrick J Hensley³, Aditya Srinivasan⁴, Amanda M De Hoedt², Sanjay Das^{2

5

6}, Stephen J Freedland^{2

6

7}, Stephen B Williams⁴

Affiliations

¹ Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
² Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA.
³ Department of Urology, University of Kentucky College of Medicine, Lexington, KY, USA.
⁴ Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
⁵ Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA.
⁶ Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁷ Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PMID: 38680113
DOI: 10.1111/bju.16380

Abstract

Objective: To describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal-access healthcare system.

Methods: This retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa-specific mortality with cumulative incidence estimates.

Results: Of 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle-invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98-1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67-1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa-specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75-1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38-0.82).

Conclusions: Black patients presented with the highest rates of de novo MIBC. However, in a large, equal-access healthcare system, this did not result in a difference in BCa-specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa-specific mortality.

Keywords: bladder cancer; disparities; equal access; muscle‐invasive bladder cancer; race.

Abstract

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