The Role of Socioeconomic Status in Influencing Stage at Presentation and Overall Survival in Bladder Cancer: Experience From the West of Scotland

TL;DR

This study finds that lower socioeconomic status is linked to worse survival in bladder cancer patients, but not to more advanced cancer stages at diagnosis.

Contribution

This is the first study to show that socioeconomic status does not influence stage at presentation in bladder cancer.

Findings

Lower socioeconomic status was associated with a 25% higher hazard of death in bladder cancer patients.

Socioeconomic status did not affect the stage at which bladder cancer was diagnosed.

Female patients were more likely to present with advanced bladder cancer.

Abstract

Introduction

Bladder cancer is responsible for significant reductions in health-related quality of life and societal and economic burden. Despite this, large-scale studies on the relationship between socioeconomic differences and bladder cancer outcomes are lacking. In light of this, we conducted a regional retrospective cohort analysis to determine whether deprivation had an impact on the stage at presentation or overall survival (OS) in patients with bladder cancer.

Methods

Demographic and clinical information were collated on every patient diagnosed with bladder cancer (all TNM stages) in the West of Scotland over five years (n = 3,089). The Scottish Index of Multiple Deprivation (SIMD) quintiles were used as a surrogate for socioeconomic status. Multivariable logistic regression and Cox models were applied to evaluate the impact of social deprivation on both the stage at presentation and OS in bladder cancer patients.

Results

In the multivariate Cox model, the less deprived had a lower hazard of death (hazard ratio (HR): 0.80, 95% confidence interval (CI): 0.70-0.91, p < 0.05). The proportion presenting with muscle invasive bladder cancer MIBC was 24.6% in the more deprived group (SIMD: 1-3; 512/2,078), and 24.4% in the less deprived group (SIMD: 4-5; 247/1,011), p = 0.94. More females presented with MIBC (28.3%; 252/890) than males (23.1%; 507/2,199). Muscle-invasive disease was strongly associated with mortality (HR: 4.97, 95% CI: 4.38-5.62, p < 0.05). Age was independently associated with mortality (HR: 1.04 per year, 95% CI: 1.04-1.05, p < 0.05). Sex was not associated with OS after adjustment (HR: 0.97, 95% CI: 0.85-1.11, p = 0.70).

Conclusions

Lower socioeconomic status was associated with a negative effect on overall survival in bladder cancer within this cohort, conferring an approximately 25% higher hazard of death. These findings are consistent with previous studies. Female patients were found to present with more advanced disease, which also correlates with existing literature. However, to the best of our knowledge, this is the first study to demonstrate that socioeconomic status in patients with bladder cancer does not influence stage at presentation. This finding contradicts existing evidence and warrants further investigation.

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