{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:14:16Z","timestamp":1779905656570,"version":"3.53.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Bladder cancer represents one of the most common malignancies in the United States, with mortality trends reflecting disease burden and clinical management effectiveness. This study aimed to comprehensively analyze long-term trends and demographic disparities in bladder cancer mortality among US adults from 1999 to 2020 using national data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Mortality data with bladder cancer (ICD-10 code: C67) as the underlying cause of death were extracted from the CDC WONDER database for 1999-2020.AAMR was calculated. Joinpoint regression models were employed to calculate APC and AAPC to identify temporal trends and inflection points in mortality rates. Stratified analyses were conducted by sex, age group, race\/ethnicity, urbanization level, and geographic region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1999 to 2020, a total of 319,229 adult deaths in the United States had bladder cancer as the underlying cause of death. Overall age-adjusted mortality rates declined from 6.737 per 100,000 in 1999 to 6.159 per 100,000 in 2020 (AAPC: -0.410, 95% CI: -0.495 to -0.310, P &amp;lt; 0.001). Joinpoint regression analysis revealed a significant decline trend after 2016 (APC changed from -0.347 to -2.118). Stratified analysis showed that male mortality rates were significantly higher than female rates. White populations had the highest recorded mortality rate (7.003 per 100,000), though this likely reflects diagnostic coding biases rather than true biological differences. Regional disparities existed, with the Northeast showing the highest mortality rates. Non-metropolitan residents had higher mortality rates (6.887 per 100,000) compared to metropolitan residents (6.64 per 100,000).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over the past two decades, bladder cancer mortality among US adults has demonstrated an overall declining trend, reflecting advances in diagnostic and therapeutic technologies. However, significant disparities by sex, race, and geographic region persist, indicating prominent health inequality issues. Future efforts should focus on strengthening early screening, smoking cessation interventions, and standardized treatment for high-risk populations to further reduce disease burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1713506","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T05:21:28Z","timestamp":1772428888000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Evolving patterns of bladder cancer mortality in US adults: a two-decade analysis reveals persistent disparities despite overall progress (1999-2020)"],"prefix":"10.3389","volume":"16","author":[{"given":"Lingfeng","family":"Sun","sequence":"first","affiliation":[{"name":"The First Clinical Medical College, Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Urology Department of Urology, LU\u2019AN Hospital of Anhui Medical University","place":["Lu\u2019an, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology Department of Urology, LU\u2019AN Hospital of Anhui Medical University","place":["Lu\u2019an, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yuan","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College, Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.eururo.2016.06.010","article-title":"Bladder cancer incidence and mortality: A global overview and recent trends","volume":"71","author":"Antoni","year":"2017","journal-title":"Eur urology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA: Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s00345-009-0395-z","article-title":"Economic aspects of bladder cancer: what are the benefits and costs","volume":"27","author":"Sievert","year":"2009","journal-title":"World J Urol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-019-02984-4","article-title":"The global burden of urinary bladder cancer: an update","volume":"38","author":"Richters","year":"2020","journal-title":"World J urology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.08.037","article-title":"Gender and bladder cancer: A collaborative review of etiology, biology, and outcomes","volume":"69","author":"Dobruch","year":"2016","journal-title":"Eur urology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.06.020","article-title":"Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer","volume":"71","author":"Alfred Witjes","year":"2017","journal-title":"Eur urology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-017-0902-2","article-title":"Population-based assessment of racial\/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer","volume":"28","author":"Williams","year":"2017","journal-title":"Cancer causes control: CCC"},{"key":"B8","doi-asserted-by":"publisher","first-page":"397","DOI":"10.15585\/mmwr.mm7111a1","article-title":"Tobacco product use among adults - United States, 2020","volume":"71","author":"Cornelius","year":"2022","journal-title":"MMWR Morbidity mortality weekly Rep"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1142","article-title":"Association between smoking and risk of bladder cancer among men and women","volume":"306","author":"Freedman","year":"2011","journal-title":"Jama"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.3209","article-title":"Contemporary occupational carcinogen exposure and bladder cancer: A systematic review and meta-analysis","volume":"1","author":"Cumberbatch","year":"2015","journal-title":"JAMA Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-6051.24.05876-2","article-title":"Assessing the influence of smoking on inflammatory markers in bacillus Calmette Gu\u00e9rin response among bladder cancer patients: a novel machine-learning approach","volume":"77","author":"Ferro","year":"2025","journal-title":"Minerva Urol Nephrol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2024.11.015","article-title":"Impact of smoking exposure on disease progression in high risk and very high-risk nonmuscle invasive bladder cancer patients undergoing BCG therapy","volume":"43","author":"Contieri","year":"2025","journal-title":"Urol Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2019.08.016","article-title":"European association of urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ) - 2019 update","volume":"76","author":"Babjuk","year":"2019","journal-title":"Eur urology"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1613683","article-title":"Pembrolizumab as second-line therapy for advanced urothelial carcinoma","volume":"376","author":"Bellmunt","year":"2017","journal-title":"New Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2021-1151","article-title":"Erdafitinib in locally advanced\/metastatic urothelial carcinoma with certain FGFR genetic alterations","volume":"18","author":"Franza","year":"2022","journal-title":"Future Oncol (London England)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1186\/s12885-016-2832-x","article-title":"Incidence and Survival of urothelial carcinoma of the urinary bladder in Norway 1981-2014","volume":"16","author":"Andreassen","year":"2016","journal-title":"BMC cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.106","article-title":"Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients","volume":"108","author":"Noon","year":"2013","journal-title":"Br J cancer"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2016.04.008","article-title":"Underutilization of radical cystectomy among patients diagnosed with clinical stage T2 muscle-invasive bladder cancer","volume":"3","author":"Williams","year":"2017","journal-title":"Eur Urol Focus"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.08.042","article-title":"Volume outcomes of cystectomy\u2013is it the surgeon or the setting","volume":"188","author":"Morgan","year":"2012","journal-title":"J Urol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.eururo.2013.08.033","article-title":"Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials","volume":"66","author":"Leow","year":"2014","journal-title":"Eur urology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"111114","DOI":"10.1016\/j.injury.2023.111114","article-title":"Twenty-year United States national, demographic and regional mortality trends from traumatic thoracic aortic injury, 1999 to 2019","volume":"55","author":"Shariff","year":"2024","journal-title":"Injury"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"B24","article-title":"Epidemiology, etiology and prevention of bladder cancer","volume":"73","author":"Rozanec","year":"2020","journal-title":"Archivos espanoles Urol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33297-X","article-title":"Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial","volume":"391","author":"Powles","year":"2018","journal-title":"Lancet (London England)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1038\/s44276-024-00104-3","article-title":"Long-term survival following anti-PD-(L)1 monotherapy in advanced urothelial cancer and an assessment of potential prognostic clinical factors: a multicentre observational study","volume":"2","author":"Stockem","year":"2024","journal-title":"BJC Rep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.urology.2008.01.086","article-title":"Patterns of hematuria referral to urologists: does a gender disparity exist","volume":"72","author":"Johnson","year":"2008","journal-title":"Urology"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28416","article-title":"Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: a nationwide claims-based investigation","volume":"120","author":"Cohn","year":"2014","journal-title":"Cancer"},{"key":"B29","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.juro.2017.11.150","article-title":"Gender specific differences in disease-free, cancer specific and overall survival after radical cystectomy for bladder cancer: A systematic review and meta-analysis","volume":"200","author":"Uhlig","year":"2018","journal-title":"J urology"},{"key":"B30","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s12894-023-01293-8","article-title":"Racial disparities in conditional survival of patients with bladder cancer: a population-based study","volume":"23","author":"Liu","year":"2023","journal-title":"BMC urology"},{"key":"B31","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1353\/hub.2002.0011","article-title":"Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national data bases","volume":"74","author":"Singh","year":"2002","journal-title":"Hum Biol"},{"key":"B32","first-page":"1","article-title":"The validity of race and Hispanic origin reporting on death certificates in the United States","author":"Arias","year":"2008","journal-title":"Vital Health Stat 2"},{"key":"B33","volume-title":"Unequal treatment: confronting racial and ethnic disparities in health care","author":"Smedley","year":"2003"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.9.1207","article-title":"Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988-1994)","volume":"161","author":"Coresh","year":"2001","journal-title":"Arch Intern Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3322\/canjclin.54.2.78","article-title":"Cancer disparities by race\/ethnicity and socioeconomic status","volume":"54","author":"Ward","year":"2004","journal-title":"CA Cancer J Clin"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djx030","article-title":"Annual report to the nation on the status of cancer, 1975-2014, featuring survival","volume":"109","author":"Jemal","year":"2017","journal-title":"J Natl Cancer Institute"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-17-0092","article-title":"Making the case for investment in rural cancer control: an analysis of rural cancer incidence, mortality, and funding trends","volume":"26","author":"Blake","year":"2017","journal-title":"Cancer epidemiology Biomarkers prevention: Publ Am Assoc Cancer Research cosponsored by Am Soc Prev Oncol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1200\/EDBK_350478","article-title":"Geography should not be an \u201cOncologic destiny\u201d for urothelial cancer: improving access to care by removing local, regional, and international barriers","volume":"42","author":"Joshi","year":"2022","journal-title":"Am Soc Clin Oncol Educ book Am Soc Clin Oncol Annu Meeting"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-020-01366-1","article-title":"Bladder cancer stage and mortality: urban vs. rural residency","volume":"32","author":"Deuker","year":"2021","journal-title":"Cancer causes control: CCC"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1354663","article-title":"Trends in genitourinary cancer mortality in the United States: analysis of the CDC-WONDER database 1999-2020","volume":"12","author":"Ghazwani","year":"2024","journal-title":"Front Public Health"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1038\/ncpuro1315","article-title":"Bladder cancer in the elderly: clinical outcomes, basic mechanisms, and future research direction","volume":"6","author":"Taylor","year":"2009","journal-title":"Nat Clin Pract Urology"},{"key":"B42","doi-asserted-by":"publisher","first-page":"101922","DOI":"10.1016\/j.pmedr.2022.101922","article-title":"Cancer disparities related to poverty and rurality for 22 top cancers in Florida","volume":"29","author":"Hall","year":"2022","journal-title":"Prev Med Rep"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1713506\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T05:21:30Z","timestamp":1772428890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1713506\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":42,"alternative-id":["10.3389\/fonc.2026.1713506"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1713506","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]},"article-number":"1713506"}}