title: The Influence of Race on Overall Survival in Patients with Newly Diagnosed Bladder Cancer.
abstract: BACKGROUND
  Previous studies have reported significant lower incidence yet greater risk of death from bladder cancer (BCa) in African-Americans compared with Caucasians. In this study, the overall survival amongst African-Americans and Caucasians with BCa within the state of Florida is evaluated.
  
  
  METHODS
  The Florida Cancer Data System and the Florida Agency for Health Care Administration data sets were linked on the basis of unique identifiers, which identified 28,786 patients (27,811 Caucasian and 975 African-Americans) with newly diagnosed BCa from January 1994-December 2009. Data in the database included race/ethnicity, age, smoking history, insurance status, treatment, tumor grade, tumor stage, and overall survival. Chi-square and Mann-Whitney U tests were used to compare variables between African-Americans and Caucasians. Survival rates were calculated by the Kaplan-Meier method while univariate effects were tested by the log-rank test, and multivariate effects were tested by Cox proportional-hazard regression model. P values less than 0.05 were considered statistically significant.
  
  
  RESULTS
  Higher clinical stage bladder tumors including T3/4 disease (14.5 % vs. 8.0 %, p < 0.001), lymph node involvement (7.3 % vs. 3.4 %, p < 0.001), and metastatic disease (5.3 % vs. 1.7 %, p < 0.001), as well as higher grade disease (60.2 % vs. 48 %, p < 0.001) were more commonly reported in African-Americans than in Caucasians with newly diagnosed BCa. African-Americans tended to be treated with more aggressive therapies (e.g., radical cystectomy). After adjusting for all covariates, African-Americans actually had more favorable outcomes as related to overall survival (HR = 0.35, 95 % CI, 0.12-0.98, p = 0.045).
  
  
  CONCLUSIONS
  Though African-Americans initially present with more aggressive BCa, African-Americans actually have an improved overall survival compared with Caucasians. Though contrary to previous reports, our results may signify a more complex relationship between race and BCa outcomes and thus warrants further attention.
authors: Section of Urologic Oncology, MD Anderson Cancer Center Orlando, Orlando, FL, 32806, USA. casey.dedeugd@gmail.com.|College of Medicine, University of Central Florida, Orlando, FL, 32827, USA. casey.dedeugd@gmail.com.
authors: Casey
authors: C
authors: DeDeugd
authors: Section of Urologic Oncology, MD Anderson Cancer Center Orlando, Orlando, FL, 32806, USA. makitomiyake@yahoo.co.jp.
authors: Makito
authors: M
authors: Miyake
authors: Section of Urologic Oncology, MD Anderson Cancer Center Orlando, Orlando, FL, 32806, USA. dieguin_chivo@hotmail.com.
authors: Diego Aguilar
authors: DA
authors: Palacios
authors: Section of Urologic Oncology, MD Anderson Cancer Center Orlando, Orlando, FL, 32806, USA. crosser@cc.hawaii.edu.|Clinical and Translational Research Program, University of Hawaii Cancer Center, 701 Ilalo St, Rm 327, Honolulu, HI, 96813, USA. crosser@cc.hawaii.edu.
authors: Charles J
authors: CJ
authors: Rosser
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005431:Florida / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000208:ethnology* / Q000401:mortality*; D044465:White People / Q000706:statistics & numerical data*
keywords: Black; Bladder cancer; Disparity; Overall survival