Socioeconomic disparities and bladder cancer stage at diagnosis: a statewide cohort analysis
Menée aux Etats-Unis à partir de données 2004–2019 portant sur 29 010 patients atteints d'un cancer de la vessie, cette étude de cohorte rétrospective analyse les disparités socioéconomiques dans le stade au diagnostic
Background and Objective: Bladder cancer (BC) is the ninth most common cancer worldwide. Despite its prevalence, large-scale studies on the relationship between socioeconomic disparities and disease stage at presentation are lacking. This study examines the association between the Area Deprivation Index (ADI), a robust measure of socioeconomic status, and stage at diagnosis among BC patients.
Materials and Methods: Patients diagnosed with BC (Any T, N, M) from the Michigan Department of Health and Human Services (2004–2019) were retrospectively analyzed. ADI was assigned based on patients’ residential census block group and stratified into quartiles, with the 4th quartile (ADI 75–100) representing the most deprived. Multivariable logistic regression tested the impact of ADI on advanced disease stages (≥T2, cN+, cM+).
Results: Among 29,010 patients, the majority were Non-Hispanic Whites (92%), males (75%), and residents in metropolitan areas (81%). Patients in the 3rd and 4th ADI quartiles had higher rates of ≥T2 (22%, 24.5%) compared to the 1st and 2nd quartiles (18%, 19.5%) (p < .001), as well as increased rates of cN + (3.4%, 3.7%) and cM + (2.8%, 3.2%) (p < .001). Multivariable regression showed that each 10-unit rise in ADI increased odds of ≥T2 by 4% (95% CI 1.03–1.06, p < .001), cN+ by 4% (95% CI 1.01–1.07, p = .038), and cM+ by 6% (95% CI 1.02–1.09, p = .003).
Conclusion: Higher ADI correlates with advanced BC stages at diagnosis. Addressing these disparities is essential to improve outcomes in BC care.
JNCI Cancer Spectrum , résumé, 2025