Longitudinal analysis of bladder cancer-specific mortality trends in the United States.

Abstract

445 Background: Bladder cancer is the most common malignancy of the urinary system. Advances in diagnosis, imaging, and treatments have led to improvements in bladder cancer management. Recent data demonstrate decreasing bladder cancer-specific mortality (BCSM) rates between 2014-2018 for both males and females, however, these trends have not been further examined by race, ethnicity, or geographical location. Using a comprehensive dataset of BCSM over 2 decades, we sought to evaluate differences in BCSM rates overall and by sex, race, ethnicity, location and urbanization category in the United States (US). Methods: Age-adjusted mortality rates for bladder cancer (ICD10 code 67) were obtained for males and females of all ages in the US from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. BCSM rates from 1999-2019 were estimated using linear regression. BSCM trends were evaluated by sex, race (White vs. Black), ethnicity (Hispanic vs. Non-Hispanic), urbanization category, and census region. BCSM rates were compared by F-test. Data analysis was performed using SAS 9.4. All p-values are based on a two-sided hypothesis test with values < 0.05 considered statistically significant. Results: From 1999-2019, age-adjusted BCSM rate overall has decreased linearly by (-)0.0073 per 100,000 population/year (p < 0.05). Evaluating by sex, both female [(-)0.131] and male [(-)0.022] BCSM rates decreased yearly (p < 0.05). By ethnicity, male Hispanic and female Non-Hispanic patients had significantly decreasing BCSM rates [(-)0.021 and (-)0.011, respectively, p < 0.05]. White patients had a slightly decreasing rate of BCSM [(-)0.0003, p = NS] while Black patients had an increasing BCSM rate [(+)0.022, p < 0.05] – the difference between the two rates was significant (p < 0.0001). BCSM rates were significantly decreasing in all census regions (Northeast, Midwest, South, Midwest, p < 0.05). BCSM rate in micropolitan (rural) regions has increased yearly [(+)0.006], and rate differences between rural vs large fringe metro (suburban) and vs small metro (population < 250,000) categories, both with significantly decreasing BCSM rates, were statistically significant (p = 0.03 and p = 0.047, respectively). Conclusions: Using comprehensive data on BCSM in the United States over two decades, we demonstrate that the overall mortality rate from bladder cancer has been decreasing. However, when disaggregating age-adjusted BCSM by sex, race, ethnicity, census regions, and urbanization categories, significant differences in mortality rates are found including worsening mortality for Black patients, demonstrating that improvements in BCSM are not equitable across variables. Further evaluation of these trends is important to understand how to target specific populations to improve BCSM and overall outcomes for all patients with bladder cancer.