Socioeconomic factors associated with stages of bladder cancer at diagnosis: Analysis of the National Cancer Database.

Abstract

e16531 Background: The average 5-year survival rate of Bladder Cancer (BC) in the US is 77%, yet the 5-year survival for BC with metastatic disease is 5%. The extreme differences in survival rate based on stage and metastasis highlight the importance of determining the social factors at the time of diagnosis. The objective of this study is to identify the socioeconomic and demographic factors associated with receiving a delayed bladder cancer diagnosis (stage IV) vs an early (stage 0-I) diagnosis. Methods: Using the National Cancer Database, this study analyzed 511,177 patients diagnosed with stage 0-I and stage IV BC between 2004 and 2018. Patients were analyzed based on race, sex, insurance type, Charlson-Deyo comorbidity score, level of education, income, geographic location, and education. Socioeconomic factors of patients were analyzed using multivariate analysis, chi square analysis, and one-way ANOVA. Results: Significant (P < 0.05) associations were identified between certain socioeconomic factors and presentation of bladder cancer at an advanced stage (stage IV). African Americans were 66% more likely to be diagnosed with stage IV diagnosis compared to Caucasians (p < .001 and 95% CI = 1.598-1.724). Hispanics were 22% more likely than non-Hispanics to present with a stage IV diagnosis (p < .001 and 95% CI = 1.114-1.327). Females were 34% more likely than men to present with stage IV diagnosis (p < .001 and 95% CI = 1.307-1.367). Patients with private insurance were 53% less likely to be diagnosed with a stage IV diagnosis than those who were uninsured (p < .001 and 95% CI = 0.448-0.509). Patients with one or more co-morbidities (Charleson-Deyo score ≥1) were more likely to present with a stage IV diagnosis than those with no co-morbidities (p < .001). Patients whose median household income was ≥ $63,000 were 33% less likely to present with a stage IV diagnosis than those whose median household income was < $63,000 (p < .031). Conclusions: Factors associated with increased likelihood of bladder cancer presentation at advanced stage compared to early stage include race, ethnicity, sex, insurance status, one or more co-morbidities, and a median household income under $63,000.