Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: A nationwide claims‐based investigation

Abstract

Background Women have disproportionately higher mortality rates relative to incidence for bladder cancer. Multiple etiologies have been proposed, including delayed diagnosis and treatment. Guidelines recommend rule-out of malignancy in men and women presenting with hematuria. We aimed to determine the difference in timing from presentation with hematuria to diagnosis of bladder cancer in women versus men. Methods This is a retrospective population-based study examining the timing from presentation with hematuria to diagnosis of bladder cancer, based on data from the MarketScan databases, which include enrollees of more than 100 health insurances plans of approximately 40 large US employers from 2004 through 2010. All study patients presented with hematuria and were subsequently diagnosed with bladder cancer. The primary outcome measure was number of days between initial presentation with hematuria and diagnosis of bladder cancer by gender. Results 5416 men and 2233 women met inclusion criteria. Mean days from initial hematuria claim to bladder cancer claim was significantly longer in women (85.4 vs. 73.6 days, p<0.001), and the proportion of women with >6 month delays in bladder cancer diagnosis significantly higher (17.3% vs. 14.1%, p<0.001). Women were more likely to be diagnosed with urinary tract infection (OR 2.32 [95% CI 2.07–2.59]) and less likely to undergo abdominal or pelvic imaging (OR 0.80 [95% CI 0.71–0.89]). Conclusions Both men and women experience significant delays between presentation with hematuria and diagnosis of bladder cancer, with longer delays for women. This may be partly responsible for the gender-based discrepancy in outcomes associated with bladder cancer.

Epidemiologie des Harnblasenkarzinoms in Deutschland

“…Die auch aus internationalen Daten bekannten Geschlechterunterschiede bei der Stadienverteilung bzw. bei den Überle-bensraten werden unter anderem durch eine mögliche Verzögerung der Diagnostik bei Frauen sowie hormon-und genetisch bedingte Unterschiede der Tumorbiologie begründet [14,15].…”

Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes

“…In this group, men were twice as likely to be referred within a month of their hematuria compared to women (36 vs. 17%). A retrospective review of MarketScan databases for hematuria also demonstrated a significant delay to diagnosis in women who were more likely to experience a delay greater than 6 months (17.3 vs. 14.1%, p < 0.001) [11]. …”

Gender, Race, and Variation in the Evaluation of Microscopic Hematuria Among Medicare Beneficiaries

“…The 6-month time frame was chosen based on the established literature, with delays longer than 6 months being associated with adverse outcomes. 12,13 Secondary endpoints included provider contribution to the hematuria evaluation by type and utility of the hematuria evaluation. Medicare specialty codes were used to determine whether the subject was seen by a urologist (Medicare specialty code 34), and whether the urologist performed one of the relevant procedures in the 6 months after hematuria diagnosis.…”