Gender disparities in bladder cancer: A population-based study on life expectancy and health spending in Asia

Abstract

Background The aim of this study was to elucidate the disparities in life expectancy, loss-of-life expectancy, and lifetime medical expenditure between sexes in patients with bladder cancer. Methods In this retrospective study, we used three Taiwanese databases to analyze the data of patients diagnosed with bladder cancer between 2008 and 2019. Patients aged <30 years or >90 years were excluded. Survival and lifetime costs were estimated using the Kaplan–Meier and semiparametric methods. Subgroup analyses were performed to examine the effects of cancer stage, age, and factors such as hemodialysis on patient outcomes and costs. Results This study included 30,390 new diagnoses of bladder cancer. Disparities in loss-of-life expectancy between men and women were observed in both non-muscle-invasive bladder cancer (3.17 [0.55] years for men vs. 7.14 [0.76] years for women) and muscle-invasive bladder cancer (8.86 [0.43] years for men vs. 10.64 [0.63] years for women). Carcinoma in situ revealed its profound impact, with the associated loss-of-life expectancy mirroring those of advanced stages (combined sex carcinoma in situ: 8.58 years, stage 2 men: 9.48 years, stage 2 women: 9.53 years). The cost per life-year showed a marked difference, especially for non-muscle-invasive bladder cancer ($4,631 for men vs. $7,636 for women) and muscle-invasive bladder cancer ($6,033 for men vs. $7,753 for women). Hemodialysis accounted for a significant portion of these costs, with hemodialysis rates of 4.6% in men and 18.5% in women. Conclusions Women have a higher prevalence of high-grade histopathology and an extended duration of hemodialysis, culminating in inferior outcomes in non-muscle-invasive bladder cancer and muscle-invasive bladder cancer and augmented costs, compared with men. The role of hemodialysis and the carcinoma in situ stage highlights the need for vigilant monitoring and early aggressive treatment strategies.