{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:24:45Z","timestamp":1788477885559,"version":"build-2803163510"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec015\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec016\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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 &lt;30 years or &gt;90 years were excluded. Survival and lifetime costs were estimated using the Kaplan\u2013Meier 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec017\">\n<jats:title>Results<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec018\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323803","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T17:35:21Z","timestamp":1749058521000},"page":"e0323803","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Gender disparities in bladder cancer: A population-based study on life expectancy and health spending in Asia"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7733-6467","authenticated-orcid":true,"given":"Yi Hong","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6080-7231","authenticated-orcid":true,"given":"Yen-Chuan","family":"Ou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Che","family":"Tung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Sheng","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya Chu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying Ming","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao Yu","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"issue":"5","key":"pone.0323803.ref001","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.euo.2020.08.013","article-title":"Sex Differences in Bladder Cancer Immunobiology and Outcomes: A Collaborative Review with Implications for Treatment","volume":"3","author":"M Koti","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"pone.0323803.ref002","author":"IARC","year":"2020"},{"issue":"10","key":"pone.0323803.ref003","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1080\/14737140.2020.1813029","article-title":"Gender discrepancies in bladder cancer: potential explanations","volume":"20","author":"P Viswambaram","year":"2020","journal-title":"Expert Rev Anticancer Ther"},{"issue":"3","key":"pone.0323803.ref004","first-page":"240","article-title":"Sex-related differences in non-urothelial variant histology, non-muscle invasive bladder cancer","volume":"75","author":"RS Flammia","year":"2022","journal-title":"Cent European J Urol"},{"issue":"5","key":"pone.0323803.ref005","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12051776","article-title":"The effect of sex on disease stage and survival after radical cystectomy in non-urothelial variant-histology bladder cancer","volume":"12","author":"RS Flammia","journal-title":"J Clin Med"},{"issue":"1","key":"pone.0323803.ref006","article-title":"Gender disparities in clinical outcomes of urothelial carcinoma linked to X chromosome gene KDM6A mutation","volume":"2","author":"Z Liu","year":"2023","journal-title":"BMJ Oncol"},{"key":"pone.0323803.ref007","article-title":"Data resource profile: the national health insurance research database (NHIRD)","volume":"40","author":"L Lin","year":"2018","journal-title":"Epidemiol Health"},{"key":"pone.0323803.ref008","author":"Ministry of the Interior, Republic of China (Taiwan)","year":"2023"},{"issue":"12","key":"pone.0323803.ref009","article-title":"Estimating lifetime medical costs from censored claims data","volume":"26","author":"J-S Hwang","year":"2017","journal-title":"Health Econ"},{"issue":"12","key":"pone.0323803.ref010","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jfma.2015.10.011","article-title":"Incidence and survival of adult cancer patients in Taiwan, 2002-2012","volume":"115","author":"CJ Chiang","year":"2016","journal-title":"J Formos Med Assoc"},{"issue":"22","key":"pone.0323803.ref011","doi-asserted-by":"crossref","first-page":"5235","DOI":"10.1002\/cncr.25310","article-title":"Delays in diagnosis and bladder cancer mortality","volume":"116","author":"BK Hollenbeck","year":"2010","journal-title":"Cancer"},{"issue":"6","key":"pone.0323803.ref012","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.euf.2017.08.007","article-title":"Gender-specific Differences in Recurrence of Non-muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis","volume":"4","author":"A Uhlig","year":"2018","journal-title":"Eur Urol Focus"},{"issue":"4","key":"pone.0323803.ref013","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s00345-022-04116-x","article-title":"Impact of sex on outcomes after surgery for non-muscle-invasive and muscle-invasive bladder urothelial carcinoma: a systematic review and meta-analysis","volume":"41","author":"K Mori","year":"2023","journal-title":"World J Urol"},{"issue":"5","key":"pone.0323803.ref014","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.euf.2021.06.007","article-title":"Prognostic implications of treatment delays for patients with non-muscle-invasive bladder cancer","volume":"8","author":"S Ourfali","year":"2022","journal-title":"Eur Urol Focus"},{"issue":"1","key":"pone.0323803.ref015","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.juro.2010.03.032","article-title":"Clinical outcomes of primary bladder carcinoma in situ in a contemporary series","volume":"184","author":"DC Chade","year":"2010","journal-title":"J Urol"},{"issue":"3","key":"pone.0323803.ref016","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.21037\/tau.2020.03.40","article-title":"Clinical outcomes and survival differences between primary, secondary and concomitants carcinoma in situ of urinary bladder treated with BCG immunotherapy","volume":"9","author":"R Piszczek","year":"2020","journal-title":"Transl Androl Urol"},{"issue":"1","key":"pone.0323803.ref017","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/JU.0000000000000788","article-title":"Differential Effect of Sex on Outcomes after Radical Surgery for Upper Tract and Bladder Urothelial Carcinoma: A Systematic Review and Meta-Analysis","volume":"204","author":"K Mori","year":"2020","journal-title":"J Urol"},{"issue":"4","key":"pone.0323803.ref018","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1159\/000368418","article-title":"Sex Differences of \u2265 pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients","volume":"94","author":"T Waldhoer","year":"2015","journal-title":"Urol Int"},{"issue":"9","key":"pone.0323803.ref019","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1007\/s00345-022-04080-6","article-title":"Sex differences in treatment patterns for non-advanced muscle-invasive bladder cancer: a descriptive analysis of 3484 patients of the Netherlands Cancer Registry","volume":"40","author":"A Richters","year":"2022","journal-title":"World J Urol"},{"issue":"1","key":"pone.0323803.ref020","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.euf.2019.06.001","article-title":"Sex-specific Differences in the Quality of Treatment of Muscle-invasive Bladder Cancer Do Not Explain the Overall Survival Discrepancy","volume":"7","author":"MJ Krimphove","year":"2021","journal-title":"Eur Urol Focus"},{"issue":"2","key":"pone.0323803.ref021","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.clgc.2019.11.007","article-title":"Impact of Gender on Chemotherapeutic Response and Oncologic Outcomes in Patients Treated With Radical Cystectomy and Perioperative Chemotherapy for Bladder Cancer: A Systematic Review and Meta-Analysis","volume":"18","author":"S Kimura","year":"2020","journal-title":"Clin Genitourin Cancer"},{"issue":"4","key":"pone.0323803.ref022","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12041260","article-title":"Diminishing the gender-related disparity in survival among chemotherapy pre-treated patients after radical cystectomy-a multicenter observational study","volume":"12","author":"K Kaczmarek","year":"2023","journal-title":"J Clin Med"},{"key":"pone.0323803.ref023","doi-asserted-by":"crossref","first-page":"100326","DOI":"10.1016\/j.jcpo.2022.100326","article-title":"Socio-economic burden of disease: Survivorship costs for bladder cancer","volume":"32","author":"JC Michaeli","year":"2022","journal-title":"J Cancer Policy"},{"issue":"5","key":"pone.0323803.ref024","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1002\/art.41597","article-title":"Lifetime Risks, Life Expectancy, and Health Care Expenditures for Rheumatoid Arthritis: A Nationwide Cohort Followed Up From 2003 to 2016","volume":"73","author":"Y-M Chiu","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"pone.0323803.ref025","article-title":"Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017","volume":"14","author":"H-Y Chiu","year":"2023","journal-title":"Ther Adv Chronic Dis"},{"issue":"8","key":"pone.0323803.ref026","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2019.1629","article-title":"Comparison of costs of radical cystectomy vs trimodal therapy for patients with localized muscle-invasive bladder cancer","volume":"154","author":"S Williams","year":"2019","journal-title":"JAMA Surg"},{"issue":"6","key":"pone.0323803.ref027","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/s41581-022-00542-7","article-title":"Epidemiology of haemodialysis outcomes","volume":"18","author":"AK Bello","year":"2022","journal-title":"Nat Rev Nephrol"},{"issue":"2","key":"pone.0323803.ref028","article-title":"Gender and Age Differences of Genitourinary Cancers Among Chronic Dialysis Patients in Taiwan","volume":"20","author":"C-H Tang","year":"2022","journal-title":"Clin Genitourin Cancer"},{"issue":"4","key":"pone.0323803.ref029","doi-asserted-by":"crossref","first-page":"346","DOI":"10.4111\/icu.20230063","article-title":"Effect of decreased renal function on poor oncological outcome after radical cystectomy","volume":"64","author":"D Kim","year":"2023","journal-title":"Investig Clin Urol"},{"issue":"8","key":"pone.0323803.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/j.urolonc.2022.04.010","article-title":"Chronic kidney disease and radical cystectomy for bladder cancer: perioperative and oncologic outcomes in 1,214 patients","volume":"40","author":"C Nguyen","year":"2022","journal-title":"Urol Oncol"},{"issue":"5","key":"pone.0323803.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/j.urolonc.2017.12.024","article-title":"Perioperative and long-term outcomes after radical cystectomy in hemodialysis patients","volume":"36","author":"S Johnson","year":"2018","journal-title":"Urol Oncol"},{"key":"pone.0323803.ref032","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.urology.2018.10.027","article-title":"The Perioperative Morbidity of Transurethral Resection of Bladder Tumor: Implications for Quality Improvement","volume":"125","author":"JF Pereira","year":"2019","journal-title":"Urology"},{"key":"pone.0323803.ref033","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ejca.2018.03.001","article-title":"Bladder cancer survival: Women better off in the long run","volume":"95","author":"BK Andreassen","year":"2018","journal-title":"Eur J Cancer"},{"issue":"12","key":"pone.0323803.ref034","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.urolonc.2019.08.001","article-title":"Bladder cancer survival: Women only fare worse in the first two years after diagnosis","volume":"37","author":"A Richters","year":"2019","journal-title":"Urol Oncol"},{"issue":"1","key":"pone.0323803.ref035","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1002\/cam4.4917","article-title":"Racial inequity and other social disparities in the diagnosis and management of bladder cancer","volume":"12","author":"S Hasan","year":"2023","journal-title":"Cancer Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T17:35:31Z","timestamp":1749058531000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323803"}},"subtitle":[],"editor":[{"given":"Mazyar","family":"Zahir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323803","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]}}}