ObjectiveTo describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal‐access healthcare system.MethodsThis retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa‐specific mortality with cumulative incidence estimates.ResultsOf 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle‐invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98–1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67–1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa‐specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75–1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38–0.82).ConclusionsBlack patients presented with the highest rates of de novo MIBC. However, in a large, equal‐access healthcare system, this did not result in a difference in BCa‐specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa‐specific mortality.

中文翻译：

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美国退伍军人事务部医疗系统膀胱癌诊断阶段的种族差异

目的描述国家平等医疗保健系统内不同人群中膀胱癌 (BCa) 诊断的患者特征和病理阶段。方法这项回顾性队列研究确定了 2000 年以来在退伍军人事务部 (VA) 医疗保健系统中诊断为 BCa 的 15 966 名男性到 2020 年。主要结局是诊断时的病理分期，由经尿道膀胱肿瘤切除术确定。使用逻辑回归来评估种族和阶段之间的关系。竞争风险模型测试了种族和 BCa 特异性死亡率与累积发病率估计之间的关联。结果 在 15 966 名 BCa 患者中，12 868 名 (81%)、1726 名 (11%)、493 名 (3%) 和 879 名 (6%) 是白人、黑人、西班牙裔和其他种族。黑人患者的肌层浸润性膀胱癌 (MIBC) 发病率显着高于白人患者（35% vs 32%；磷= 0.009）。在多变量分析中，黑人和白人患者（比值比 [OR] 1.10，95% 置信区间 [CI] 0.98–1.22）或西班牙裔患者（OR 0.82，95% CI 0.67）之间出现 MIBC 的几率没有显着差异。 –1.01) 和白人患者。与白人患者相比，黑人患者的 BCa 特异性死亡风险相似（风险比 [HR] 0.89，95% CI 0.75–1.06），而西班牙裔患者的风险较低（HR 0.56，95% CI 0.38–0.82）结论黑人患者的患病率最高从头MIBC。然而，在一个大型、平等的医疗保健系统中，这并没有导致 BCa 特异性死亡率的差异。相比之下，西班牙裔患者发生 MIBC 和 BCa 特异性死亡的风险较低。