Health care disparities and bladder cancer mortality in the United States: A closer look at the social vulnerability index.

150 Background: Bladder cancer is a significant public health concern, with various factors influencing mortality rates. The Social Vulnerability Index (SVI) measures community resilience to external health stresses. This study investigates the association between bladder cancer mortality (BCM) and county-level SVI in the United States (U.S.). Methods: Mortality data from U.S. counties were obtained from the Centers for Disease Control (CDC) and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 2015 to 2019 using the International Classification of Diseases-10th Edition (Code C67). The CDC and Agency for Toxic Substances and Disease Registry (ATSDR) county-level SVI was used as a composite measure of social vulnerability. The SVI includes several U.S. census variables grouped into four themes: Socioeconomic Status (SES), Household Characteristics, Racial and Ethnic Minority Status, and Housing Type and Transportation. Vulnerable SES variables include individuals with incomes below 150% of the federal poverty line, unemployment, those with housing cost burdens, and those without high school diplomas or health insurance. Vulnerable household variables include seniors over 65 years, children under 17 years, disabled civilians, single-parent households, and those with limited English proficiency. SVI Quartiles (Q1 being the least vulnerable and Q4 the most vulnerable) were compared to assess their impact on BCM. Negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) with 95% Confidence Intervals (CIs) using SAS software. Results: From 2015 to 2019, a total of 82,994 people died from bladder cancer, and the age-adjusted mortality rate per 1,000,000 was 42.4. A higher SVI in intermediate vulnerability quartiles was associated with a higher risk of BCM (Q2 and Q3: IRR = 1.06; 95% CI = 1.01-1.10; p = 0.009) compared to the least vulnerable quartile, Q1. Vulnerable SES had an increased risk of BCM (Q2 and Q3: IRR = 1.07; 95% CI = 1.03-1.12; p 0.9 Household Characteristics Q1 — — Q2&Q3 1.06 1.02, 1.10 0.004 Q4 1.05 1.00, 1.10 0.052 Racial & Ethnic Minority Status Q1 — — Q2&Q3 0.88 0.84, 0.92 <0.001 Q4 0.77 0.73, 0.81 <0.001 Housing Type & Transportation Q1 — — Q2&Q3 1.03 0.99, 1.08 0.2 Q4 0.98 0.93, 1.03 0.4 IRR = Incidence Rate Ratio, CI = Confidence Interval.