Persistent Sex Disparities in Bladder Cancer Diagnosis: An Analysis of National Trends From 2012 to 2021

Women diagnosed with bladder cancer (BCa) are more likely to die of their disease as compared with men. Historical data suggest that this difference is in part due to delayed diagnosis, as the initial symptoms of BCa are often attributed to other causes, including UTI. Whether efforts to address this disparity have resulted in improvements in time to diagnosis in women is unknown.

We used the Merative MarketScan database to identify men and women diagnosed with BCa from January 2012 to December 2021 who had documented hematuria or UTI within the preceding year. The primary end point was time to BCa diagnosis following initial diagnosis of hematuria or UTI.

A total of 12,667 patients with hematuria and 2350 patients with UTIs were included in our study. The median time to diagnosis was similar for women compared with men when the presenting diagnosis was hematuria (35.0 days, IQR: 14.0-79.8 vs 33.0 days, IQR: 14.0-69.0, P = .005) and longer when the presenting diagnosis was a UTI (82.0 days, IQR: 29.0-180.0 vs 63.0 days, IQR: 18.8-156.0, P < .001). Women presenting with hematuria were more likely to receive a subsequent diagnosis of UTI (28% vs 18%, P < .001) before BCa diagnosis. Men were less likely to experience delays in diagnosis of > 3 months (odds ratio 0.83, 95% CI: 0.79-0.91).

Women continue to experience delays in BCa diagnosis, especially following diagnosis with a UTI. Our findings suggest that this disparity is driven largely by clinical suspicion of UTI.