Supportive-care burden among bladder cancer survivors in the United States: a nationally representative NHIS study

To evaluate self-rated health, acute-care use, and socioeconomic vulnerability among bladder cancer survivors in a nationally representative US sample.

We pooled 2019-2024 National Health Interview Survey data. Adults were classified as no cancer, bladder cancer survivors, or survivors of other cancers; bladder cancer survivors with additional cancer histories remained in the primary group, with sensitivity analyses restricted to survivors without additional cancer histories. Outcomes were poor/fair self-rated health, all-cause emergency room use, and all-cause overnight hospitalization. Survey-weighted logistic models estimated odds ratios and adjusted risk differences (ARDs) by marginal standardization; modified Poisson models estimated prevalence ratios (PRs).

Among 172,100 adults, 651 were bladder cancer survivors. After enhanced adjustment, bladder cancer survivorship was associated with poor/fair self-rated health versus no cancer (PR, 1.58; 95% CI, 1.42-1.77; ARD, 8.83 percentage points) and versus other cancers (PR, 1.22; 95% CI, 1.09-1.36; ARD, 6.09 percentage points). Hospitalization was higher in both comparisons, whereas emergency room use attenuated versus other cancers. Among bladder cancer survivors, 42.5% reported additional cancer histories. Restricted sensitivity analyses retained associations versus adults without cancer, whereas cancer-comparator associations attenuated and their confidence intervals included the null. Poor/fair health burden was highest below poverty level.

Bladder cancer survivors had excess supportive-care burden, especially self-rated health and hospitalization. Multiple cancer histories appeared to partly explain the excess burden versus other cancer survivors. Health-status assessment, symptom triage, navigation, and support should prioritize older, socioeconomically vulnerable, and medically complex survivors.