Bladder cancer mortality among smokers: Trends and disparities in U.S. adults (1999–2023).

Abstract

e16612 Background: Bladder cancer ranks as the 10th leading cause of cancer death in the United States (US), with over 81,000 new cases and 17,100 deaths annually. Survival rates have stagnated over the past three decades. Tobacco smoking, the most established risk factor, accounts for 50–65% of cases in men and 20–30% in women. This study investigates gender, racial, and geographic disparities in bladder cancer-related mortality rates among smokers in the U.S. from 1999–2023, to evaluate the impact of tobacco use on public health. Methods: We analyzed the CDC WONDER database for death certificates (1999-2023) for adults aged 45+ with bladder cancer and tobacco use, using the following ICD-10 codes: C67 (malignant neoplasm of the bladder) and F17 (tobacco use). We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals, and trends in AAMR were assessed using annual percent change (APC) and average annual percent change (AAPC) via JoinPoint regression. Results: From 1999 to 2023, a total of 62,369 deaths were reported among smokers with bladder cancer in the US. The AAMR rose from 0.2 in 1999 to 2.7 in 2023 showing a significant increase (AAPC: 12.83%, 95% CI= 11.16–16.13). Mortality trends increased from 1999 to 2005 (APC 47.5*, 95% CI = 35.3–69.3), followed by a steady rise until 2012 (APC 7.3*, 95% CI =5.6–9.7), and a period of relative stability from 2012 to 2023 (APC 0.6, 95% CI = -0.09–1.2). AAMRs increased in both males and females (AAPC 12.80% [11.10–17.94] and 12.09% [10.30–17.18], respectively). Males had consistently higher AAMR from 1999 ( 0.3 vs 0.1) to 2023 (4.9 vs 1.0). Non-Hispanic (NH) Whites had the highest change in AAMR (AAPC=13.12%), followed by NH Black or African American (6.6%), Hispanics (5.6%), NH Asian or Pacific Islanders (0.8%), and NH American Indian or Alaska Natives (-0.9%). AAMR varied by region with the South having the highest AAPC (12.18%) followed by the Midwest (12.08%), West (11.58%), and Northeast (9.76%). Rural areas had higher AAMR (2.5) than Urban areas (1.7). States above the 90th percentile include Vermont, Oregon, North Dakota, New Hampshire, Idaho, and Montana. Conclusions: This analysis shows a sharp rise in bladder cancer mortality among smokers (1999–2023), particularly among males, NH Whites, rural residents, and those in the Southern US.This highlights the need for targeted strategies to address the risk factors and prevent contributing events. Average annual percent change in bladder cancer mortality rates among smokers by demographic group (1999–2023). Variable Deaths Average Annual Percent Change (95% CI) Overall 62369 12.83 (11.16 to 16.13) Male 49571 12.80 (11.10 to 17.94) Female 12798 12.09 (10.30 to 17.18) NH White 57128 13.12 (11.35 to 16.38) NH Asian or Pacific Islander 344 0.89 (-2.35 to 4.49) NH Black or African American 3096 6.66 (5.18 to 12.06) NH American Indians or Alaskan Native 190 -0.93 (-3.47 to 2.45) Hispanics or Latino 1328 5.65 (4.08 to 9.61)