Sex and racial differences in bladder cancer presentation and mortality in the US.
BACKGROUND
Sex, race, and age at diagnosis have a significant impact on mortality from bladder cancer (BC). Women, African Americans of both sexes, and the elderly, all experience higher mortality rates. Tumor grade, stage, and histologic type at presentation also affect outcome. To determine whether age and tumor characteristics alone explain the excess hazard of death from BC observed in some demographic groups, the authors queried the Surveillance, Epidemiology, and End Results (SEER) limited-use database for the presentations and outcomes from BC between 1990 and 2005.


METHODS
Tumors were characterized by grade, stage, and histologic type. Hazards rates for BC-specific mortality were compared by race and sex using a piecewise Cox regression model, adjusting for factors (age, stage, grade, and histologic type) that differed significantly between the groups that were compared.


RESULTS
Excess hazard of death from BC was present during the first 2 to 3 years of follow-up among women and during the first 4 years of follow-up among African Americans. Adjustment for age and tumor characteristics eliminated approximately 30% of this excess hazard in sex comparison among whites. In sex comparison among blacks and in racial comparisons within each sex, approximately 50% to 70% of excess hazard could be eliminated by adjustment.


CONCLUSIONS
Significant differences in tumor characteristics and age at presentation did not fully account for the excess hazard of death from BC among women and African Americans. Other factors, such as choice and efficacy of therapies, differences within a given tumor characteristic group, and/or host factors also may play important roles.
Scosyrev
Emil
E
Department of Community and Preventive Medicine, University of Rochester, Rochester, New York 14642, USA.
Noyes
Katia
K
Feng
Changyong
C
Messing
Edward
E
D001741:Black or African American; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D018426:SEER Program; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D044465:White People