Session: PD29: Bladder Cancer: Epidemiology & Evaluation II
PD29-11: Disparities in Stage at Diagnosis Among Black Bladder Cancer Patients in the Largest Equal Access Health System in the US: The Veterans Affairs Health System
Introduction: While Whites are more likely to be diagnosed with bladder cancer (BCa ), Blacks are more commonly diagnosed with advanced stage and have increased risk of BCa-specific mortality (BCSM). The impact of many social determinants of health, including equal access to care, remain to be determined. We describe patient characteristics and pathologic stage at BCa diagnosis in a racially diverse population within a national, equal-access healthcare system. Methods: This retrospective cohort study identified 16,585 men diagnosed with BCa in the US Department of Veterans Affairs (VA) from 2000-2020 who met inclusion criteria. Association between patient characteristics and race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Other) were evaluated using chi-square and Kruskal-Wallis tests for categorical and continuous variables, respectively . The primary outcome was pathologic stage (NMIBC vs. MIBC) at diagnosis determined by natural language processing of initial diagnostic transurethral resection of bladder tumor. Multivariable competing risks regression tested the association between race and BCSM and the cumulative incidence of BCSM was calculated. Results: Of 16,585 BCa patients, 13,086 (79%), 1,773 (11%), 534 (3%), and 1192 (7%) were White, Black, Hispanic, and Other race, respectively. Blacks were significantly more likely to be diagnosed with MIBC vs. Whites (35% vs. 32%, p=0.003). In multivariable analysis, race was also significantly associated with MIBC (p=0.023) . Blacks were more likely to be diagnosed with MIBC than Whites (odds ratio [OR] 1.10, 95% CI 1.00-1.22), whereas Hispanics were less likely to have MIBC than Whites (OR 0.82, 95% CI 0.68-1.00). Race was also significantly associated with BCSM in multivariable analysis (p < 0.001). Compared to Whites, BCSM was similar in Blacks (HR 1.03, 95% CI 0.88-1.22), while Hispanics had lower BCSM (HR 0.53, 95% CI 0.36-0.78). Conclusions: While Blacks were slightly more likely to present with de novo MIBC, in a large, equal-access healthcare system, this resulted in no increased risk of BCSM compared to Whites. In contrast, Hispanics had lower risk of MIBC and BCSM. SOURCE OF Funding: SBW: DOD Peer Reviewed Cancer Research Program Career Development Award (W81XWH1710576) . SD: PCORT UroGynCan (T32CA251072)
