Overall and recurrence-free survival among black and white bladder cancer patients in an equal-access health system

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

An eight-long non-coding RNA signature as a candidate prognostic biomarker for bladder cancer

“…DeDeugd et al found that African-Americans initially present with more aggressive BLCA, however, African-Americans actually have an improved overall survival compared with Caucasians [23]. However, Schinkel et al reported that white and black patients with BLCA were not significantly different in overall and recurrence-free survival regardless of muscle invasion [24]. In the present study, when the patients with BLCA were stratified by race, the results showed that for the Caucasians, they can be divided into either a high-risk group with shorter survival or a low-risk group with longer survival according to the eight-lncRNA signature.…”

<p>Ribosome Binding Protein 1 Correlates with Prognosis and Cell Proliferation in Bladder Cancer</p>

“…4,5 Furthermore, bladder cancer presents a high recurrence rate and mortality rate because of the absence of typical symptoms at the early stage. 6,7 No reliable biomarkers are helpful for clinical therapy and survival estimation. [8][9][10] Therefore, identifying effective biomarkers for early diagnosis and prognosis assessment is needed for the clinical therapy of bladder cancer.…”

Impact of tumor, treatment, and access on outcomes in bladder cancer: Can equal access overcome race‐based differences in survival?

“…Generally, these studies have suggested that access to care is a major contributor to disparities: For example, using a (fully insured) Medicare population, Schmid et al 8 found disparities in prostate cancer outcomes, as did Cullen et al 9 using a Veterans Affairs population. Similarly, Schinkel et al 22 found that patients with bladder cancer within a US Department of Defense cohort experienced fewer disparities in overall and recurrence-free survival.…”

“…19,20 There are also some ecological data indicating that racial and ethnic differences may be lessened in equal-access health systems. 21,22 In this setting, we designed a study to compare the overall survival of black and white patients diagnosed with localized muscle-invasive bladder cancer and to assess the relative contributions of tumor characteristics, treatment type, and access-related factors (insurance, income, education, and distance to a hospital) to the excess risk of death among blacks. We hypothesized that black individuals with bladder cancer would have worse overall survival than white patients and that access-related variables (insurance, education, income, and distance to a hospital) would explain the majority of the excess mortality in black men and women with bladder cancer.…”