Area deprivation and cancer-specific mortality in non-muscle-invasive bladder cancer: a statewide analysis.

OBJECTIVES

To evaluate whether neighbourhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), is associated with cancer-specific mortality (CSM) in patients with non-muscle-invasive bladder cancer (NMIBC).

PATIENTS AND

METHODS

We retrospectively reviewed patients with NMIBC (T stage <2, node-negative, non-metastatic) from Michigan Cancer Surveillance Program (2004-2019). ADI national percentiles were assigned based on residential census block groups and stratified into quartiles, with the fourth quartile (ADI 75-100) being the most deprived. Cumulative incidence functions compared CSM between quartiles, and competing-risk regression analysis assessed the association between ADI and CSM after adjusting for covariates.

RESULTS

Among 19 722 patients (92.2% non-Hispanic White; median [interquartile range] age 72 [64-80] years; 76.7% male), most resided in metropolitan areas (81%) and 61% were married. Overall, 8.5%, 26.4%, 34.9%, and 30.2% of patients were in the first, second, third, and fourth ADI quartile, respectively. At 10 years, the cumulative incidence of CSM was 7.3%, 7.9%, 8.7%, and 9.7% across the first-fourth quartiles, respectively (P = 0.002). At the competing risk analysis, each 25-point increase in ADI was associated with a 6% higher hazard of CSM (95% confidence interval 1.01-1.12; P = 0.032). Older age, higher T stage, unmarried status, and Medicaid insurance were independently associated with greater CSM.

CONCLUSIONS

Higher ADI was associated with increased CSM in our cohort. Evaluating socioeconomic context in NMIBC care may inform follow-up and therapy and, potentially, influence progression and mortality.