Demographic and socioeconomic disparities in early-onset vs. late-onset bladder cancer: A cross-sectional study in the NIH All of Us research program.

Abstract

657 Background: Bladder cancer typically presents after age 60, but cases diagnosed before age 60 (early-onset) may show distinct demographic and socioeconomic profiles. Using NIH All of Us, we characterized disparities in early- vs late-onset bladder cancer. Methods: Cross-sectional analysis of 1,669 adults with incident bladder cancer in All of Us (Registered Tier) (early-onset <60, n=222; late-onset ≥60, n=1,447). We compared age at diagnosis, sex, simplified race/ethnicity (White, Hispanic, Black, Asian, Other), and neighborhood-level socioeconomic z-scores (median income, high-school completion, poverty, assisted-income reliance, uninsured rate, vacant housing, deprivation index, composite SES). Categorical variables were analyzed with χ² tests; continuous (age and SES z-scores) with Welch t-tests. Results: Early-onset patients were younger (mean age 52.3 vs. 71.4 years; p<0.001), more often female (38.3% vs. 26.7%; p = 0.0012), and more Hispanic (16.7% vs. 5.7%; p<0.001), Black (17.1% vs. 5.3%; p < 0.001), and Asian (3.2% vs. 0.7%; p<0.001), with fewer White (57.2% vs. 80.4%; p<0.001). Neighborhood deprivation (deprivation index +0.22 vs. –0.03; p<0.001), uninsurance (+0.21 vs. –0.03; p = 0.0015), and poverty (+0.17 vs. –0.03; p = 0.0074) z-scores were higher, while median income (–0.14 vs. +0.02; p = 0.024) and high-school completion (–0.20 vs. +0.03; p = 0.002) were lower. Conclusions: Early-onset bladder cancer is enriched for women and racial/ethnic minorities and clusters in disadvantaged areas. These differences implicate social determinants–limited health care access, occupational/environmental exposures, and economic hardship, may accelerate onset in vulnerable populations, underscoring targeted prevention and earlier detection. Demographic, race/ethnicity, and socioeconomic characteristics of early- vs late-onset bladder cancer, All of Us research program (N = 1,669). Category Feature Early_Onset (n = 222) Late_Onset (n = 1447) p-value Ethnicity/Race Hispanic 16.7% 5.7% < 0.001 White 57.2% 80.4% < 0.001 Other or unknown 5.9% 7.9% < 0.001 Black 17.1% 5.3% < 0.001 Asian 3.2% 0.7% < 0.001 Demographics Female 38.3% 26.7% 0.001 Other or unknown 1.30% 1.10% 0.001 Male 60.4% 72.2% 0.001 Socioeconomic No health insurance 0.21 ± 1.08 -0.03 ± 0.98 0.001 SES composite index 0.12 ± 0.63 -0.02 ± 0.61 0.001 High School education -0.20 ± 1.03 0.03 ± 0.99 0.001 Assisted income 0.19 ± 1.05 -0.03 ± 0.99 0.01 Poverty 0.17 ± 1.03 -0.03 ± 0.99 0.01 Median income -0.14 ± 0.97 0.02 ± 1.00 0.02 Vacant housing 0.14 ± 1.06 -0.02 ± 0.99 0.03 Deprivation index 0.22 ± 1.01 -0.03 ± 0.99 < 0.001 Data are column percentages unless noted; socioeconomic measures are standardized z-scores and shown as mean ± SD. p-values from χ² tests (categorical) and t tests (continuous). Early-onset < 60 years; late-onset ≥ 60 years. Abbreviations: SES, socioeconomic status.