Disparities and temporal trends in referral for bladder cancer diagnosis: A worsening epidemic.

PURPOSE: To analyze temporal trends in time intervals from hematuria diagnosis to urology evaluation and cystoscopy in patients with bladder cancer and identify opportunities for improved interventions.

MATERIALS AND

METHODS

We identified 84,515 Medicare beneficiaries in the SEER-Medicare database diagnosed with bladder cancer between 2005 and 2019, with hematuria claims within 12 months prior to diagnosis and urology visits thereafter. The co-primary outcome was delay (>30 days) and severe delay (>60 days) from hematuria claim to urology visit. The secondary outcome was delay (>14 days) and severe delay (>30 days) from urology visit to cystoscopy. We used joinpoint regression and logistic regression analyses.

RESULTS

Delays from hematuria claim to urology visit increased over time; the proportion of patients experiencing a delay of over 30 days rose from 30.8% in 2005 to 35.1% in 2016, (Annual Percent Change (APC) 0.89%, P = NS).This trend accelerated significantly after 2016, reaching 39.2% in 2019 (APC 3.68%, P < 0.001). Females faced higher rates of delays throughout the study period. Females were 1.40 times more likely to experience a delay in their urology visit than males (aOR 1.40, 95% CI 1.34-1.46). Other variables associated with delay included Black and Hispanic race/ethnicity, not married, higher Charlson score, and residence. A preexisting relationship with a urologist reduced the delay likelihood (aOR 0.83, 95% CI 0.79-0.87).

CONCLUSIONS

Female patients continue to experience a disproportionately delayed urologic referral which has, unfortunately. worsened over time. To ensure equitable and timely diagnosis of bladder cancer, future interventions must focus on streamlining the initial referral process.