Impact of Social and Structural Determinants of Health on Bladder Cancer Outcomes: Focus on Non-Muscle-Invasive Disease.

Non-muscle-invasive bladder cancer (NMIBC) requires repeated procedures, long-term surveillance, and sustained access to urologic care. Outcomes are highly sensitive to health disparities. This article examines how social determinants of health including insurance status, socioeconomic factors, gender, ethnicity, geography, and care fragmentation can impact NMIBC care. Delays in hematuria evaluation, underuse and inequitable distribution of intravesical therapy, and decreased surveillance adherence contribute to higher recurrence, progression, and worse quality-of-life outcomes. These disparities may be driven primarily by differences in care delivery rather than tumor biology. Targeted system-level and policy interventions are needed.