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Persisting Sex Disparities in Bladder Cancer Outcomes over Time: A Population-Based SEER Study
Liang G. Qu, MD1, Lorelei Mucci, MPH2, Labeeqa Khizir, MD3, Steven L. Chang, MD3, Adam Feldman, MD3, Adam S. Kibel, MD3, Matthew Mossanen, MD3.
1Austin Health, , Heidelberg, Australia, 2Harvard T.H. Chan School of Public Health, Boston, MA, USA, 3Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND: Recent projections of bladder cancer deaths suggest an increase in deaths for women compared to men by 2040. It is unclear whether this disparity is reflected in proportion of late-stage diagnoses, and survival outcomes. Our aim is to examine differences between sex in temporal trends in bladder cancer stage at presentation and survival.
METHODS: This study utilized SEER data from 2000 to 2022, examining patients aged 18-90, with bladder cancer. Covariates included: age, sex, race, income, rurality, marital status, subtype, grade, stage, and survival. Primary outcomes included probability of late-stage bladder cancer diagnosis using multivariable logistic regression, and overall survival by stage using multivariable Cox regression. Secondary analysis was performed for cancer-specific survival.
RESULTS: In total, 254,671 patients were included (60,223 were female). A total of 58,067 patients had late-stage disease (muscle-invasive or metastatic). Logistic regression demonstrated that women were at higher odds of late-stage disease compared to men (OR: 1.24, 95% confidence interval: 1.17 to 1.31, p<0.01). Upon Cox regression analysis, women with stage II disease experienced worse overall survival compared to men in the period 2015+ (HR: 1.07, 1.01 to 1.15, p=0.03), reflecting the effect of the sex-time interaction. Sex disparities were similarly observed for more advanced disease (stage III and IV), and when analysing cancer-specific survival (p <0.01).
CONCLUSION: Women were more likely to be diagnosed with late-stage disease. Women who were diagnosed with late-stage disease were observed to have worse survival compared to men.
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