Impact of declining renal function on bladder cancer (BC) mortality in the U.S. (1999-2023): A regression analysis using the CDC WONDER database.

Abstract

e16619 Background: BC is associated with significant renal-related mortality. This is attributed to chemotherapy, acute kidney injury (AKI), chronic kidney disease (CKD) with possible dialysis. Older adults are particularly vulnerable due to age-related declines in renal function, comorbidities, and higher prevalence rates. We aimed to evaluate renal-related events as a cause of death in bladder cancer patients, with a focus on demographic trends and the preferred place of death (PPOD) in the U.S. Methods: A nationwide U.S. healthcare database, CDC WONDER, was utilized to assess mortality trends in patients over > 65. Mortality data were categorized using the ICD-10 codes: C67 for bladder cancer, N17-N19 for renal failure, R94.4 for abnormal kidney function studies, and Y84.1 for kidney dialysis. Joinpoint 5.0 software was used for regression analysis to evaluate mortality trends. Data were stratified by demographic factors, including census region, race, sex, and PPOD. Results: The overall trends indicated a significant increase in renal-related mortality from 1999 to 2012 (APC 1.4812, p = 0.000076), followed by an insignificant decline from 2012 to 2015, and a significant increase from 2015 to 2023 (APC 3.1013, p = 0.000078). On census stratification, significantly increased mortality was noted Midwest (1999-2023: APC 0.5492, p = 0.01) and the West (1999-2005: APC 5.0920, p = 0.001809; 2015-2023: APC 2.8382, p = 0.00399). The South also showed significant increasing trends from 1999 to 2018, with an exponential surge from 2018 to 2023 (APC 5.6142, p = 0.005395). By race, notable increases were observed in the Asian population (1999-2023: APC 3.8522, p = 0.000027) and the White population (1999-2012: APC 1.6140, p = 0.0003; 2015-2023: APC 2.878, p = 0.00017). For sex stratification, males showed significant mortality increases, with trends from 1999 to 2012 (APC 2.0621, p = 0.000005) and from 2015 to 2023 (APC 3.2988, p = 0.000111). Regarding PPOD, deaths in hospice, nursing homes, and home settings showed increasing trends from 1999 to 2023 (APC 2.4073, p < 0.000001), while mortality in medical facilities declined from 1999 to 2020 (APC -1.89, p < 0.000001), followed by an exponential surge from 2020 to 2023 (APC 14.5803, p = 0.007). Conclusions: Our study reveals a concerning rise in renal-related mortality among bladder cancer patients who are older adults, males, and Asians. We also highlighted the geographic trends with the midwest, west, and south being the most affected regions. Evolving PPOD patterns suggest increased hospice use, which suggests improved access to end-of-life care. Our findings reveal a potential intervention group within BC patients that can benefit from multi-disciplinary care with nephrology. Further research is needed to uncover the factors driving these trends.