{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:06:59Z","timestamp":1759961219421},"reference-count":26,"publisher":"Royal College of General Practitioners","issue":"698","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Pre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate associations in bladder cancer between: first, pre-existing condition count and advanced-stage diagnosis; and, second, comorbidities that share symptoms with bladder cancer and advanced-stage diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>This observational UK cohort study was set in the Clinical Practice Research Datalink with Public Health England National Cancer Registration and Analysis Service linkage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Included participants were aged \u226540 years with an incident diagnosis of bladder cancer between 1 January 2000 and 31 December 2015, and primary care records of attendance for haematuria, dysuria, or abdominal mass in the year before diagnosis. Stage at diagnosis (stage 1 or 2 versus stage 3 or 4) was the outcome variable. Putative explanatory variables using logistic regression were examined, including patient-level count of pre-existing conditions and \u2018alternative-explanations\u2019, indicating whether pre-existing condition(s) were plausible diagnostic alternatives for the index cancer symptom.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 1468 patients (76.4% male) were studied, of which 399 (35.6%) males and 217 (62.5%) females had alternative explanations for their index cancer symptom, the most common being urinary tract infection with haematuria. Females were more likely than males to be diagnosed with advanced-stage cancer (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] = 1.20 to 2.18; <jats:italic>P<\/jats:italic> = 0.001). Alternative explanations were strongly associated with advanced-stage diagnosis in both sexes (aOR 1.69; 95% CI = 1.20 to 2.39; <jats:italic>P<\/jats:italic> = 0.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Alternative explanations were associated with advanced-stage diagnosis of bladder cancer. Females were more likely than males to be diagnosed with advanced-stage disease, but the effect was not driven entirely by alternative explanations.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp20x710921","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T04:22:36Z","timestamp":1594700556000},"page":"e629-e635","source":"Crossref","is-referenced-by-count":10,"title":["Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK"],"prefix":"10.3399","volume":"70","author":[{"given":"Madeline","family":"Carney","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myra","family":"Quiroga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Mounce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Shephard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willie","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Price","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2020,7,13]]},"reference":[{"key":"2021010810254297000_70.698.e629.1","unstructured":"Cancer Research UK Bladder cancer statistics www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/bladder-cancer (accessed 29 Jun 2020)."},{"key":"2021010810254297000_70.698.e629.2","unstructured":"International Agency for Research on Cancer Cancer Today 2018 gco.iarc.fr\/today\/home (accessed 29 Jun 2020)."},{"key":"2021010810254297000_70.698.e629.3","unstructured":"Office for National Statistics Cancer survival by stage at diagnosis for England (experimental statistics): adults diagnosed 2012, 2013 and 2014 and followed up to 2015 2016 https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/bulletins\/cancersurvivalbystageatdiagnosisforenglandexperimentalstatistics\/adultsdiagnosed20122013and2014andfollowedupto2015 (accessed 29 Jun 2020)."},{"issue":"2","key":"2021010810254297000_70.698.e629.4","doi-asserted-by":"crossref","first-page":"300","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 Urol"},{"key":"2021010810254297000_70.698.e629.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-011-0709-9"},{"issue":"3","key":"2021010810254297000_70.698.e629.6","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/S0090-4295(99)00481-1","article-title":"Gender differences in stage distribution of bladder cancer","volume":"55","author":"Mungan","year":"2000","journal-title":"Urology"},{"issue":"4","key":"2021010810254297000_70.698.e629.7","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1159\/000449256","article-title":"Closing the gender gap: can we improve bladder cancer survival in women? 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