Racial disparities in stage at bladder cancer diagnosis in the US Veterans Affairs healthcare system

Kelly K. Bree, Jessica L. Janes, Patrick J. Hensley, Aditya Srinivasan, Amanda M. De Hoedt, Sanjay Das, Stephen J. Freedland, Stephen B. Williams

Research output: Contribution to journalArticlepeer-review


Objective: To describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal-access healthcare system. Methods: This retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa-specific mortality with cumulative incidence estimates. Results: Of 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle-invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98–1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67–1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa-specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75–1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38–0.82). Conclusions: Black patients presented with the highest rates of de novo MIBC. However, in a large, equal-access healthcare system, this did not result in a difference in BCa-specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa-specific mortality.

Original languageEnglish
JournalBJU International
StateAccepted/In press - 2024

Bibliographical note

Publisher Copyright:
© 2024 BJU International.


  • bladder cancer
  • disparities
  • equal access
  • muscle-invasive bladder cancer
  • race

ASJC Scopus subject areas

  • Urology


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