Disparities in trends in bladder cancer mortality between urban and rural patients: A 2000-2020 analysis.

Abdul Rahman Al Armashi Seidman Cancer Center, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH info_outline Abdul Rahman Al Armashi, Marisa Thierheimer, Laura Bukavina, Adam C. Calaway, Randy Vince, Prateek Mendiratta, Jorge A. Garcia, Jason R Brown

Authors Abdul Rahman Al Armashi Seidman Cancer Center, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH info_outline Abdul Rahman Al Armashi, Marisa Thierheimer, Laura Bukavina, Adam C. Calaway, Randy Vince, Prateek Mendiratta, Jorge A. Garcia, Jason R Brown Organizations Seidman Cancer Center, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH, Case Western Reserve University School of Medicine, Cleveland, OH, University Hospitals, Cleveland Medical Center, Cleveland, OH, University Hospitals Seidman Cancer Center, Cleveland, OH, University Hospitals and Case Western Reserve University, Cleveland, OH, University Hospitals of Seidman Cancer Center/Case Comprehensive Cancer Center, Cleveland, OH Abstract Disclosures Research Funding No funding sources reported Background: Patients in rural areas in the US often have worse healthcare outcomes due to socioeconomic deprivation, higher rates of smoking, and limited access to medical care. Despite a general decline in bladder cancer mortality over the past two decades, comprehensive studies comparing these trends between urban and rural mortality are scarce. Methods: Utilizing the CDC WONDER database, we extracted mortality data for bladder cancer from 2000 to 2020. Age-adjusted mortality rates per 100,000 persons were standardized to the Year 2000 US standard population. Data segmentation by urbanity utilized the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. The National Cancer Institute's Joinpoint Regression Program was employed to calculate average annual percent changes (AAPCs) and annual percent changes (APCs). Results: In our analysis, we identified a total of 306,750 bladder cancer death cases from 2000 to 2020. Significant improvements in bladder cancer mortality were observed in urban areas, with large central metros experiencing the most pronounced decrease (AAPC -1.0%, p<0.001). This decline was moderate between 2000 and 2016 (APC -0.3, p< 0.001) but accelerated between 2016 and 2020 (APC -3.8%, p<0.001). Large fringe and medium metros also saw comparatively smaller but significant declines (AAPC -0.6%, P<0.05) and also accelerated between 2016-2020. In contrast, small metro and rural areas (micropolitan and noncore) showed no significant improvement, with mortality rates remaining stable between 2000 and 2020 (AAPC 0.2%, P=0.099). Conclusions: This analysis, the largest to date comparing urban and rural mortality trends in bladder cancer, highlights significant disparities in outcomes between large urban and rural areas. The marked improvement in urban areas, especially noted around the time novel agents such as immunotherapy were introduced, underscores the potential impact of advanced treatments. However, the stable mortality rates in rural areas suggest that access to advanced care, environmental influences, socioeconomic status, and slower adaptation of new guidelines in rural settings may play critical roles. These findings underline the urgent need for strategies to close the urban-rural gap. Bladder cancer mortality trends by location (2000-2020). Location AAPC (%) Joinpoints APC% (Years Specified) P-Value Large Central Metro -1.0 -3.8 (2016-2020) <0.001 Large Fringe Metro -0.6 -2.6 (2016-2020) 0.016 Medium Metro -0.6 -3.5 (2017-2020) 0.008 Small Metro -0.1 — 0.431 Micropolitan (Rural) 0.2 — 0.099 NonCore (Rural) 0.2 — 0.09 Note: A dash (—) indicates that no significant joinpoints APC was identified for the specified years in that location, implying stable mortality rates without notable changes.