title: Female, Black, and Unmarried Patients Are More Likely to Present With Metastatic Bladder Urothelial Carcinoma.
abstract: Although there are well-established risk factors for the diagnosis of bladder cancer, there is no consensus regarding risk factors for presentation of advanced or metastatic disease at diagnosis. The objective of this study was to identify the demographic and clinical factors associated with metastasis at diagnosis in patients with bladder urothelial carcinoma.
  
  
  
  Patients diagnosed with bladder urothelial carcinoma from 2004 to 2010 were identified in the Surveillance, Epidemiology, and End Results (SEER) database (n = 108,417). The primary outcome was metastatic disease at the time of diagnosis. Demographic and socioeconomic variables were analyzed, and multivariable logistic regression models were performed to generate odds ratios (OR) for factors associated with metastasis at diagnosis.
  
  
  
  Of patients with bladder cancer, 3018 (2.8%) had metastasis at diagnosis and 105,399 (97.2%) had nonmetastatic disease. Patients with metastatic disease at diagnosis were more frequently female (29.6% vs. 23.6%, P < .001), black (9.4% vs. 5.0%, P < .001), and unmarried (44.1% vs. 32.5%, P < .001) compared to patients with nonmetastatic disease. On multivariable analysis, the following characteristics were confirmed to be independently associated with metastatic disease at diagnosis: female gender (vs. male, OR 1.21), black race (vs. white, OR 1.71), unmarried (vs. married, OR 1.46), unemployed (OR 1.02), and foreign-born status (OR 1.01).
  
  
  
  Female gender, black race, unmarried, unemployed, and foreign-born status are independently associated with metastasis at diagnosis for bladder urothelial carcinoma. All clinicians should be aware of these potential health care disparities in order to involve social services and other support mechanisms in efforts to improve early care.
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA. Electronic address: zklaassen19@gmail.com.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: John M
authors.initials: JM
authors.lastname: DiBianco
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Rita P
authors.initials: RP
authors.lastname: Jen
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Austin J
authors.initials: AJ
authors.lastname: Evans
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Lael
authors.initials: L
authors.lastname: Reinstatler
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.affiliation: Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Rabii
authors.initials: R
authors.lastname: Madi
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018426:SEER Program; D012737:Sex Factors; D012847:Single Person / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*
keywords: Bladder cancer; Marital status; Metastasis; Metastasis at diagnosis; SEER