title: Bladder cancer incidence and mortality rates compared to ecologic factors among states in America.
abstract: OBJECTIVE
  Smoking, inadequate vitamin D and pesticide exposure have been linked to bladder cancer (BCa) in past studies. The objective of this study is to explore associations between BCa rates and these risk factors.
  
  
  METHODS
  BCa incidence and mortality rates among states were compared to smoking; solar ultraviolet (UV) radiation levels and drinking water from a surface water supply (which has greater residual pesticide contamination than groundwater and both are used as sources for drinking water). Lack of health insurance, median family income and urbanization were included to adjust for access to health care and socioeconomic status.
  
  
  RESULTS
  BCa incidence and mortality correlated directly with smoking and inversely with solar UV radiation for males and females. BCa mortality correlated directly with drinking surface water for both sexes. Lack of health insurance correlated inversely with BCa incidence for females and trended toward significance for males. Multivariable analyses identified solar UV radiation as the best predictor of BCa incidence in males and solar UV radiation and smoking in females. Solar UV radiation, smoking and drinking surface water were the best predictors of BCa mortality in males, while smoking and drinking surface water were the best predictors of mortality in females.
  
  
  CONCLUSIONS
  BCa incidence and mortality for both sexes correlated directly with smoking and inversely with solar UV radiation levels. BCa mortality for both sexes correlated with drinking water from a surface water source. It is hypothesized that BCa mortality risks may increase from drinking water contaminated with low levels of pesticides.
authors.affiliation: University of Alabama, Birmingham, AL, USA. jan.colli@ccc.uab.edu
authors.forename: Janet L
authors.initials: JL
authors.lastname: Colli
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kolettis
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010575:Pesticides / Q000032:analysis; D011829:Radiation Dosage; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013472:Sunlight; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D014874:Water Pollutants, Chemical / Q000032:analysis; D014881:Water Supply
chemical_list: D010575:Pesticides; D014874:Water Pollutants, Chemical