Gender Disparities in Bladder Cancer Specific Survival in High Poverty Areas Utilizing Ohio Cancer Incidence Surveillance System (OCISS)

Objectives To better understand the interplay of socioeconomic and demographic traits on bladder cancer outcomes utilizing the Ohio state cancer registry, Ohio Cancer Incidence Surveillance System (OCISS). Materials and Methods We obtained demographic, clinical and outcome data on 47,182 bladder cancer cases diagnosed from 1996-2016 from OCISS. Multivariable Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI) for the association between sex, race and poverty and survival, adjusting age, stage, and primary treatment. Results Within the OCISS database, there were 47,182 patients with a diagnosis of bladder cancer identified, with females representing 12,056 (26%) of the population. There were a total of 9,255(35.2%) deaths due to bladder cancer, with median follow up time of 4.4 years. After adjusting for confounding variables, women were statistically significantly less likely to die from any cause (HR: 0.94, 95% CI: 0.91-0.96), compared with men, but more likely to die from bladder cancer (HR: 1.21, 95% CI: 1.15-1.27). We also found that after adjusting for confounding variables, including sex and poverty, black race was statistically significantly associated with a higher risk of overall (HR: 1.12, 95% CI: 1.06-1.18) and bladder cancer-specific mortality (HR: 1.25, 95% CI: 1.15-1.36). Conclusion Using the OCISS database, female gender, self-reported black race and neighborhood poverty level were associated with worse bladder-cancer specific survival. By recognizing these disparities, we can prospectively address risk factors in efforts to improve survival among these patient populations.