Bladder cancer stage and mortality: urban vs. rural residency

Marina Deuker, L Franziska Stolzenbach, Claudia Collà Ruvolo, Luigi Nocera, Zhe Tian, Frederik C Roos, Andreas Becker, Luis A Kluth, Derya Tilki, Shahrokh F Shariat, Fred Saad, Felix K H Chun, Pierre I Karakiewicz, Marina Deuker, L Franziska Stolzenbach, Claudia Collà Ruvolo, Luigi Nocera, Zhe Tian, Frederik C Roos, Andreas Becker, Luis A Kluth, Derya Tilki, Shahrokh F Shariat, Fred Saad, Felix K H Chun, Pierre I Karakiewicz

Abstract

Objective: Relative to urban populations, rural patients may have more limited access to care, which may undermine timely bladder cancer (BCa) diagnosis and even survival.

Methods: We tested the effect of residency status (rural areas [RA < 2500 inhabitants] vs. urban clusters [UC ≥ 2500 inhabitants] vs. urbanized areas [UA, ≥50,000 inhabitants]) on BCa stage at presentation, as well as on cancer-specific mortality (CSM) and other cause mortality (OCM), according to the US Census Bureau definition. Multivariate competing risks regression (CRR) models were fitted after matching of RA or UC with UA in stage-stratified analyses.

Results: Of 222,330 patients, 3496 (1.6%) resided in RA, 25,462 (11.5%) in UC and 193,372 (87%) in UA. Age, tumor stage, radical cystectomy rates or chemotherapy use were comparable between RA, UC and UA (all p > 0.05). At 10 years, RA was associated with highest OCM followed by UC and UA (30.9% vs. 27.7% vs. 25.6%, p < 0.01). Similarly, CSM was also marginally higher in RA or UC vs. UA (20.0% vs. 20.1% vs. 18.8%, p = 0.01). In stage-stratified, fully matched CRR analyses, increased OCM and CSM only applied to stage T1 BCa patients.

Conclusion: We did not observe meaningful differences in access to treatment or stage distribution, according to residency status. However, RA and to a lesser extent UC residency status, were associated with higher OCM and marginally higher CSM in T1N0M0 patients. This observation should be further validated or refuted in additional epidemiological investigations.

Keywords: Bladder cancer; Geographical disparities; Social differences; Stage at presentation; Treatment rates.

Conflict of interest statement

Our research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Cumulative incidence plots depicting cancer-specific mortality (CSM) and other cause mortality (OCM) according to residency status (rural area [RA] vs. urban cluster [UC] vs. urbanized area [UA]) in overall bladder cancer (BCa) patients
Fig. 2
Fig. 2
Cumulative incidence plots after 1:4 matching of (a) rural area (RA) residency status (n=2,651 RA) with urbanized area (UA) residency status (n=10,604 UC), or of (b) urban cluster (UC) residency status (n=19,437 UC) with UA (n=77,748), depicting cancer-specific mortality (CSM) and other cause mortality (OCM) in stage T1N0M0 BCa patients

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