Survival Disparities Among African American Women With Invasive Bladder Cancer in Florida

BACKGROUND: The authors sought to understand the effect of patient sex, race, and socioeconomic status (SES) on outcomes for bladder cancer. METHOD: The Florida Cancer Data System and the Agency for Health Care Administration data sets (1998-2003) were merged and queried. Survival outcomes for patients with bladder cancer were compared between different races, ethnicities, and community poverty levels. RESULTS: A total of 31,100 people with bladder cancer were identified. Overall median survival time was 62.7 months. Statistically significantly longer survival times were observed in men (62.8 months vs 62.3 months for women), whites (63.0 months vs 39.6 months for African Americans [AAs], P < .001), non-Hispanics (62.9 months vs 56.4 months for Hispanics, P < .001), and patients from more affluent communities (74.0 months where <5% live in poverty vs 53.0 months where >15% live in poverty, P < .001). Surgery was associated with dramatically improved survival. AA women diagnosed with bladder cancer were significantly less likely to have endoscopic surgical resection compared with white women (P < .001). On multivariate analysis, independent predictors of poorer outcomes were older age, AA race, female sex, degree of community poverty, histologic tumor grade, advanced tumor stage, and lack of surgical treatment. CONCLUSIONS: Racial and SES disparities in bladder cancer survival were not fully explained by late-stage presentation and undertreatment. Although earlier diagnosis and greater access to surgery would likely yield some improvement in outcomes for AA women, more research is needed to understand the remaining survival gap for this population. Cancer 2009;115:4196-209. (C) 2009 American Cancer Society.