社会经济差异与膀胱癌诊断时的分期：一项全州范围的队列分析。

Socioeconomic disparities and bladder cancer stage at diagnosis: a statewide cohort analysis.

作者信息

Finocchiaro Alessio, Tylecki Anna, Viganò Silvia, Bertini Alessandro, Ficarra Vincenzo, Di Trapani Ettore, Salonia Andrea, Briganti Alberto, Montorsi Francesco, Lughezzani Giovanni, Buffi Nicolò, Sood Akshay, Rogers Craig, Abdollah Firas

机构信息

Vattikuti Urology Institute Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, United States.

Department of Biomedical Sciences, Humanitas University, Milan, Italy.

出版信息

JNCI Cancer Spectr. 2025 Jul 1;9(4). doi: 10.1093/jncics/pkaf054.

DOI:10.1093/jncics/pkaf054

PMID:40445186

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12274062/

Abstract

BACKGROUND

Bladder cancer is the ninth most common cancer worldwide. Despite its prevalence, large-scale studies on the relationship between socioeconomic disparities and disease stage at presentation are lacking. This study examines the association between the Area Deprivation Index (ADI), a robust measure of socioeconomic status, and stage at diagnosis among bladder cancer patients.

METHODS

Patients diagnosed with bladder cancer (any TNM stage) from the Michigan Department of Health and Human Services (2004-2019) were retrospectively analyzed. ADI was assigned based on patients' residential census-block group and stratified into quartiles, with the fourth quartile (ADI 75-100) representing the most deprived. Multivariable logistic regression tested the impact of ADI on advanced disease stages (muscle invasive disease [≥T2], positive nodal status [cN+], metastatic disease [cM+]).

RESULTS

Among 29 010 patients, the majority were non-Hispanic White (92%), males (75%), and residents in metropolitan areas (81%). Patients in the third and fourth ADI quartiles had higher rates of ≥T2 (22%, 24.5%) compared with the first and second quartiles (18%, 19.5%) (P < .001), as well as increased rates of cN+ (3.4%, 3.7%) and cM+ (2.8%, 3.2%) (P < .001). Multivariable regression showed that each 10-unit rise in ADI increased odds of T2 by 4% (95% CI = 1.03 to 1.06, P < .001), cN+ by 4% (95% CI = 1.01 to 1.07, P = .038), and cM+ by 6% (95% CI = 1.02 to 1.09, P = .003).

CONCLUSION

Higher ADI correlates with advanced bladder cancer stages at diagnosis. Addressing these disparities is essential to improve outcomes in bladder cancer care.

摘要

背景

膀胱癌是全球第九大常见癌症。尽管其发病率较高，但缺乏关于社会经济差异与就诊时疾病分期之间关系的大规模研究。本研究探讨了地区贫困指数（ADI）（一种衡量社会经济地位的有效指标）与膀胱癌患者诊断分期之间的关联。

方法

对密歇根州卫生与公众服务部（2004 - 2019年）诊断为膀胱癌（任何TNM分期）的患者进行回顾性分析。根据患者的居住普查街区组分配ADI，并将其分为四分位数，第四四分位数（ADI 75 - 100）代表最贫困地区。多变量逻辑回归分析测试了ADI对晚期疾病分期（肌层浸润性疾病[≥T2]、阳性淋巴结状态[cN +]、转移性疾病[cM +]）的影响。

结果

在29010名患者中，大多数为非西班牙裔白人（92%）、男性（75%）且居住在大都市地区（81%）。与第一和第二四分位数（18%，19.5%）相比，第三和第四ADI四分位数的患者≥T2的发生率更高（22%，24.5%）（P <.001），cN +（3.4%，3.7%）和cM +（2.8%，3.2%）的发生率也有所增加（P <.001）。多变量回归显示，ADI每升高10个单位，T2的发生几率增加4%（95% CI = 1.03至1.06，P <.001），cN +增加4%（95% CI = 1.01至1.07，P =.038），cM +增加6%（95% CI = 1.02至1.09，P =.003）。