No improvement in metastatic bladder cancer health disparity over the last two decades.
e18076 Background: Bladder cancer (BCa) is one of the top ten most common cancers in the world. However, very few studies have reported on health disparities involving advanced BCa. Methods: Patients with metastatic BCa diagnosed between 1991 and 2014 were identified through the California Cancer Registry. Included in the analysis were age at diagnosis, sex, race/ethnicity, area-based socioeconomic status (SES), first course of treatment, and survival time. Predictors of treatment were identified using logistic regression, and cause-specific survival was analyzed using Cox regression. Results: A total of 3,073 cases of metastatic BCa were identified. Among these cases, 67.39% were male, and 32.61% were female. The race distribution was 74.78% non-Hispanic white (NHW), 6.25% non-Hispanic black (NHB), 12.46% Hispanic and 5.96% NH Asian/Pacific Islander (Asian/PI). A Cox proportional hazards model analysis showed that NHB were more likely to die from BCa. After adjustment for sex, age, and SES quintile, the hazard ratio of overall survival for NHB over NHW was 1.18 (p=0.214) during 1991-2002, but it increased to 1.24 (p=0.041) during 2003-2014. A smaller proportion of NH black patients survived two years after diagnosis (6.5% versus 14.4% NH white, 18.3% Hispanic, and 15.4% Asian/PI). Patients over age 65, female patients and those residing in all but the wealthiest census tracts were less likely to receive chemotherapy with or without local treatment. Patients diagnosed between 2003 and 2014 were 32% more likely to receive chemotherapy than those diagnosed between 1991 and 2002 (p<.001). There was no improvement of overall survival in the most recent time period. Conclusions: There had been no improvement in this heath disparity or in overall survival over the last two decades. Non-Hispanic blacks and patients who were not treated with chemotherapy experienced poorer survival than other groups. [Table: see text]