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Bladder cancer stage and mortality: urban vs. rural residency.

Authors
  • Deuker, Marina1, 2
  • Stolzenbach, L Franziska3, 4
  • Collà Ruvolo, Claudia3, 5
  • Nocera, Luigi3, 6
  • Tian, Zhe3
  • Roos, Frederik C7
  • Becker, Andreas7
  • Kluth, Luis A7
  • Tilki, Derya4
  • Shariat, Shahrokh F8, 9, 10
  • Saad, Fred3
  • Chun, Felix K H7
  • Karakiewicz, Pierre I3
  • 1 Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. [email protected] , (Germany)
  • 2 Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. [email protected] , (Canada)
  • 3 Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. , (Canada)
  • 4 Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. , (Germany)
  • 5 Department of Urology, University of Naples Federico II, Naples, Italy. , (Italy)
  • 6 Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy. , (Italy)
  • 7 Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. , (Germany)
  • 8 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. , (Austria)
  • 9 Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
  • 10 Department of Urology, University of Jordan, Amman, Jordan. , (Jordan)
Type
Published Article
Journal
Cancer Causes & Control
Publisher
Springer-Verlag
Publication Date
Nov 23, 2020
Identifiers
DOI: 10.1007/s10552-020-01366-1
PMID: 33230694
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Relative to urban populations, rural patients may have more limited access to care, which may undermine timely bladder cancer (BCa) diagnosis and even survival. We tested the effect of residency status (rural areas [RA < 2500 inhabitants] vs. urban clusters [UC ≥ 2500 inhabitants] vs. urbanized areas [UA, ≥50,000 inhabitants]) on BCa stage at presentation, as well as on cancer-specific mortality (CSM) and other cause mortality (OCM), according to the US Census Bureau definition. Multivariate competing risks regression (CRR) models were fitted after matching of RA or UC with UA in stage-stratified analyses. Of 222,330 patients, 3496 (1.6%) resided in RA, 25,462 (11.5%) in UC and 193,372 (87%) in UA. Age, tumor stage, radical cystectomy rates or chemotherapy use were comparable between RA, UC and UA (all p > 0.05). At 10 years, RA was associated with highest OCM followed by UC and UA (30.9% vs. 27.7% vs. 25.6%, p < 0.01). Similarly, CSM was also marginally higher in RA or UC vs. UA (20.0% vs. 20.1% vs. 18.8%, p = 0.01). In stage-stratified, fully matched CRR analyses, increased OCM and CSM only applied to stage T1 BCa patients. We did not observe meaningful differences in access to treatment or stage distribution, according to residency status. However, RA and to a lesser extent UC residency status, were associated with higher OCM and marginally higher CSM in T1N0M0 patients. This observation should be further validated or refuted in additional epidemiological investigations.

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