Bladder Cancer Mortality in the United States: A Geographic and Temporal Analysis of Socioeconomic and Environmental Factors

PURPOSE - We sought to assess the association of temporal, socioeconomic and environmental factors with bladder cancer mortality in the United States. Our hypothesis was that bladder cancer mortality is associated with distinct environmental and socioeconomic factors, with their effects varying by region, race and gender.

METHODS - The National Cancer Institute age-adjusted county-level bladder cancer mortality from 1950 to 2007 was analyzed to identify clusters of increased bladder cancer death using the Getis-Ord Gi* statistic. Socioeconomic, clinical and environmental data were assessed using geographically-weighted spatial regression analysis adjusting for spatial autocorrelation. County-level socioeconomic, clinical and environmental data were obtained from national databases including the United States Census, Centers for Disease Control, National Center for Health Statistics, and County Health Rankings.

RESULTS - Bladder cancer mortality hot spots and risk factors for bladder cancer death differed significantly by gender, race and geographic region. From 1996 to 2007, smoking, unemployment, physically unhealthy days, air pollution ozone days, percentage of houses with well water, employment in the mining industry, and urban residences were all associated with increased rates of bladder cancer mortality (P < 0.05). Model fit was significantly improved in hot spots compared to all US counties (R(2) = 0.20 vs. 0.05, respectively).

CONCLUSIONS - Environmental and socioeconomic factors affect bladder cancer mortality, and their effects appear to vary by gender and race. Additionally, there were temporal trends of bladder cancer hot spots, which when persistent, should be the focus of individual-level studies of occupational and environmental factors.

J Urol. 2015 Jul 30. pii: S0022-5347(15)04499-7. doi: 10.1016/j.juro.2015.07.091. [Epub ahead of print]

Smith ND1, Prasad SM2, Patel AR3, Weiner AB3, Pariser JJ3, Razmaria A3, Maene C4, Schuble T4, Pierce B5, Steinberg GD3.

1 Section of Urology.
2 Department of Urology, Medical University of South Carolina, Charleston, SC.
3 Section of Urology.
4 Division of Social Sciences.
5 Departments of Public Health Scienecs and Human Genetics, University of Chicago Pritzker School of Medicine, Chicago, IL.