title: Overall and recurrence-free survival among black and white bladder cancer patients in an equal-access health system.
abstract: While the incidence of bladder cancer is twice as high among whites than among blacks, mortality is higher among blacks than whites. Unequal access to medical care may be an important factor. Insufficient access to care could delay cancer detection and treatment, which can result in worse survival. The purpose of this study was to evaluate whether survival differed between black and white bladder cancer patients in the Department of Defense (DoD), which provides universal healthcare to all beneficiaries regardless of racial background.
  
  
  
  This study was based on data from the U.S. DoD Automated Central Tumor Registry (ACTUR). White and black patients histologically diagnosed with bladder cancer between 1990 and 2004 were included in the study and followed to the end of 2007. The outcomes were all-cause mortality and recurrence. We assessed the relationship between race and outcomes of interest using Cox proportional hazard ratios (HRs) for all, non-muscle invasive (NMIBC), and muscle invasive (MIBC) bladder cancers, separately.
  
  
  
  The survival of black and white individuals did not differ statistically. No significant racial differences in survival (HR: 0.96, 95% CI: 0.76-1.22) or recurrence-free survival (HR: 0.94, 95% CI: 0.69-1.30) were observed after adjustment for demographic variables, tumor characteristics, and treatment. Similar findings were observed for NMIBC and MIBC patients, respectively.
  
  
  
  Black patients were more likely to present with MIBC than white patients. However, white and black patients with bladder cancer were not significantly different in overall and recurrence-free survival regardless of muscle invasion. Our study suggests the importance of equal access to healthcare in reducing racial disparities in bladder cancer survival.
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: Jill K
authors.initials: JK
authors.lastname: Schinkel
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shao
authors.affiliation: National Cancer Institute, NIH, Rockville, MD, United States.
authors.forename: Shelia H
authors.initials: SH
authors.lastname: Zahm
authors.affiliation: National Cancer Institute, NIH, Rockville, MD, United States.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, United States; General Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Electronic address: kzhu@murthacancercenter.org.
authors.forename: Kangmin
authors.initials: K
authors.lastname: Zhu
mesh_terms: D044383:Black People; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000208:ethnology* / Q000401:mortality; D044465:White People; D001741:Black or African American
keywords: Bladder cancer; Race; Survival