Gender disparities in hematuria evaluation and bladder cancer diagnosis: a population based analysis.
OBJECTIVE
Men are diagnosed with bladder cancer at 3 times the rate of women. However, women present with advanced disease and have poorer survival, suggesting delays in bladder cancer diagnosis. Hematuria is the presenting symptom in most cases. We assessed gender differences in hematuria evaluation in older adults with bladder cancer.


METHODS
Using the SEER (Surveillance, Epidemiology and End Results) cancer registry linked with Medicare claims we identified Medicare beneficiaries 66 years old or older diagnosed with bladder cancer between 2000 and 2007 with a claim for hematuria in the year before diagnosis. We examined the impact of gender, and demographic and clinical factors on time from initial hematuria claim to urology visit and on time from initial hematuria claim to hematuria evaluation, including cystoscopy, upper urinary tract imaging and urine cytology.


RESULTS
Of 35,646 patients with a hematuria claim in the year preceding bladder cancer diagnosis 97% had a urology visit claim. Mean time to urology visit was 27 days (range 0 to 377). Time to urology visit was longer for women than for men (adjusted HR 0.9, 95% CI 0.87-0.92). Women were more likely to undergo delayed (after greater than 30 days) hematuria evaluation (adjusted OR 1.13, 95% CI 1.07-1.21).


CONCLUSIONS
We observed longer time to a urology visit for women than for men presenting with hematuria. These findings may explain stage differences in bladder cancer diagnosis and inform efforts to decrease gender disparities in bladder cancer stage and outcomes.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora and Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado. Electronic address: tullika.garg@ucdenver.edu.
Tullika
T
Garg
Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Laura C
LC
Pinheiro
Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Coral L
CL
Atoria
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
S Machele
SM
Donat
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Joel S
JS
Weissman
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Harry W
HW
Herr
Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Elena B
EB
Elkin
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D011787:Quality of Health Care; D012189:Retrospective Studies; D018426:SEER Program; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology
SEER program; female; hematuria; quality of health care; urinary bladder neoplasms