TY  - JOUR
A1  - Deuker, Marina
A1  - Stolzenbach, Lara Franziska
A1  - Collà Ruvolo, Claudia
A1  - Nocera, Luigi
A1  - Tian, Zhe
A1  - Roos, Frederik
A1  - Becker, Andreas
A1  - Kluth, Luis
A1  - Tilki, Derya
A1  - Shariat, Shahrokh F.
A1  - Saad, Fred
A1  - Chun, Felix
A1  - Karakiewicz, Pierre I.
T1  - Bladder cancer stage and mortality: urban vs. rural residency
T2  - Cancer causes & control
N2  - 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.
KW  - Bladder cancer
KW  - Social differences
KW  - Stage at presentation
KW  - Geographical disparities
KW  - Treatment rates
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/81330
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-813305
SN  - 1573-7225
N1  - Open Access funding enabled and organized by Projekt DEAL.
N1  - Data availability: SEER data are publicly available. Access to the SEER database is provided for researchers by the National Health Institute.
Code availability: Custom code upon request.
VL  - 32
IS  - 2
SP  - 139
EP  - 145
PB  - Springer Nature Switzerland
CY  - Cham
ER  -