Racial and ethnic differences in bladder cancer diagnosis, treatment, and specialty care access among

Introduction: Bladder cancer (BC) is the second most common genitourinary malignancy, with substantial racial disparities in survival. This study assessed racial and ethnic differences across key stages of BC care among US Medicare beneficiaries. Methods: This cross-sectional study analyzed Medicare fee-for-service claims (2021-2022) and included patients with newly diagnosed BC (ICD-10-CM code C67). Differences in diagnosis, specialty care access, and treatment across racial and ethnic groups (White, Black or African American, Hispanic, Asian or Pacific Islander, American Indian or Alaska Native, Other, or Unknown) were evaluated using rate ratios (RRs), with White patients as the reference group. Median times from diagnosis to first specialist referral and to treatment initiation were also assessed. Outcomes are reported using descriptive statistics. Results: A total of 136, 172 patients met the study criteria: 116, 043 (85.2%) White, 7, 768 (5.7%) Black or African American, 5, 733 (4.2%) Hispanic, 2, 729 (2.0%) Asian or Pacific Islander, 365 (<1%) American Indian or Alaska Native, and 3, 534 (2.6%) patients of Other or Unknown race. The RRs for BC diagnosis and receipt of any treatment were below 1.0 across all racial and ethnic groups. Compared with White patients, Hispanic and Black or African American patients had less access to specialists (Hispanic: RR = 0.891; 95% confidence interval [CI], 0.865-0.918; Black or African American: RR = 0.930; 95% CI, 0.906-0.954), had lower rates of receiving any treatment (Hispanic: RR = 0.806; 95% CI, 0.765-0.850; Black or African American: RR = 0.814; 95% CI, 0.775-0.856), and experienced longer median times from diagnosis to treatment initiation (31 days for both groups vs 25 days for White patients). Hispanic and American Indian or Alaska Native patients also had longer median times from initial diagnosis to first specialist visit (26 and 28 days, respectively) compared with White patients (23 days). Conclusion: Racial disparities in BC care across the care continuum were observed. These findings can inform conversations with population health decision makers and policy-level stakeholders to identify solutions to help improve care for minoritized racial and ethnic groups. Further research is needed to understand the underlying drivers and develop evidence-based strategies to ensure equitable access to care for all patients.