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Disparities in cause-specific mortality by race and sex among bladder cancer patients from the SEER database

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Abstract

Purpose

Previous literature shows that more bladder cancer patients overall die from causes other than the primary malignancy. Given known disparities in bladder cancer outcomes by race and sex, we aimed to characterize differences in cause-specific mortality for bladder cancer patients by these demographics.

Methods

We identified 215,252 bladder cancer patients diagnosed with bladder cancer from 2000 to 2017 in the SEER 18 database. We calculated cumulative incidence of death from seven causes (bladder cancer, COPD, diabetes, heart disease, external, other cancer, other) to assess differences in cause-specific mortality between race and sex subgroups. We used multivariable Cox proportional hazards regression and Fine-Gray competing risk models to compare risk of bladder cancer-specific mortality between race and sex subgroups overall and stratified by cancer stage.

Results

17% of patients died from bladder cancer (n = 36,923), 30% died from other causes (n = 65,076), and 53% were alive (n = 113,253). Among those who died, the most common cause of death was bladder cancer, followed by other cancer and diseases of the heart. All race-sex subgroups were more likely than white men to die from bladder cancer. Compared to white men, white women (HR: 1.20, 95% CI: 1.17–1.23) and Black women (HR: 1.57, 95% CI: 1.49–1.66) had a higher risk of dying from bladder cancer, overall and stratified by stage.

Conclusion

Among bladder cancer patients, death from other causes especially other cancer and heart disease contributed a large proportion of mortality. We found differences in cause-specific mortality by race-sex subgroups, with Black women having a particularly high risk of dying from bladder cancer.

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Data availability

The datasets generated and analyzed during the current study are available in the Open Science Framework repository, https://osf.io/u9mty/. These data were derived from the following resource available in the public domain: Surveillance Research Program, National Cancer Institute SEER*Stat software version 8.4.0.1 [48].

Abbreviations

SEER:

Surveillance, Epidemiology, and End Results

COPD:

Chronic obstructive pulmonary disease

HR:

Hazard ratio

CI:

95% Confidence interval

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Acknowledgments

We appreciate the contributions from cancer registries supported by the National Cancer Institute’s SEER program. This study was supported with funding from the National Cancer Institute (SPORE P20CA233216) and the Mt. Sinai Health Care Foundation.

Funding

This study was supported with funding from the Division of Cancer Epidemiology and Genetics, the National Cancer Institute (SPORE P20CA233216) and the Mt. Sinai Health Care Foundation.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA

    Timothy D. Shu

  2. Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Fredrick R. Schumacher, Britt Conroy, Lee Ponsky & Sarah C. Markt

  3. Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Fredrick R. Schumacher & Sarah C. Markt

  4. Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Britt Conroy, Lee Ponsky, Amr Mahran, Laura Bukavina & Adam Calaway

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Contributions

TDS contributed to data curation, formal analysis, investigation, and writing of the original draft. SCM contributed to conceptualization, funding acquisition, formal analysis, investigation, methodology, supervision, and writing, reviewing, and editing of the manuscript. FRS, BC, LP, AM, LB, and AC contributed to investigation and writing, reviewing, and editing of the manuscript.

Corresponding author

Correspondence to Timothy D. Shu.

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The authors have no relevant financial or non-financial interests to disclose.

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The study was deemed not human subjects research by the Case Western Reserve University Institutional Review Board.

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Shu, T.D., Schumacher, F.R., Conroy, B. et al. Disparities in cause-specific mortality by race and sex among bladder cancer patients from the SEER database. Cancer Causes Control 34, 521–531 (2023). https://doi.org/10.1007/s10552-023-01679-x

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