台灣膀胱癌患者中的性別差異：預期壽命與公共衛生支出的探究

李一宏¹、歐宴泉¹、林益聖¹、楊雅筑²、邱瑩明²³、許兆畬¹、童敏哲¹

¹童綜合醫院 外科部 泌尿科，²大數據中心，³內科部 風濕免疫科

Assessing Gender Disparities in Bladder Cancer: A Study of Life Expectancy and Public Health Expenditure in Taiwan

Yi Hong Li¹, Yen Chuan Ou¹, Yi Sheng Lin¹, Ya Chu Yang², Ying Ming Chiu²³,

Chao Yu Hsu¹, Min Che Tung¹

Division of Urology, Department of Surgery¹, Department of big data research center² and Department of Allergy Immunology and Rheumatology³, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan

Purpose:

This study was to elucidate the disparities in life expectancy (LE), loss-of-life expectancy (loss-of-LE), and lifetime medical expenditure between genders among contemporary bladder cancer patients post-diagnosis, base on Taiwanese population dataset.

Materials and Methods:

This retrospective study examined bladder cancer patients diagnosed from 2008 to 2018, utilizing databases like the National Health Insurance system reimbursement database (NHIRD), National Mortality Registry, and the Taiwan Cancer Registry (TCR). Excluding patients under 30 and over 90, it used the Kaplan-Meier and semiparametric methods to estimate survival and lifetime costs (in 2019 USD). Subgroup analysis focused on cancer stages, age, and factors like hemodialysis to assess their effects on patient outcomes and costs.

Results:

The study encompassed 30,390 new bladder cancer diagnoses, underscoring significant gender disparities. Particularly in the younger demographic, female patients confronted a more considerable loss-of-LE and elevated medical costs across various cancer stages and ages. The loss-of-LE disparity between males and females was evident in Non-muscle-invasive bladder cancer (NMIBC) (3.17 (0.55) vs. 7.14 (0.76) years) and Muscle-invasive bladder cancer (MIBC) (8.86 (0.43) vs. 10.64 (0.63) years). A comprehensive analysis of carcinoma in situ (CIS) revealed its profound impact, with the associated loss-of-LE mirroring those of advanced stages (combined gender CIS: 8.58 years; stage 2 males: 9.48 years; stage 2 females: 9.53 years). The cost per life year also showcased a marked difference, especially in NMIBC ($4,631 for males vs. $7,636 for females) and in MIBC ($6,033 for males vs. $7,753 for females). When stratified by age, males peaked in cost per life year at ages 80-89 ($5,758), whereas females peaked at 30-59 ($8,308). Hemodialysis accounted for a significant portion of these costs, with a hemodialysis rate of 4.6% for males vs. 18.5% for females. Before a cancer diagnosis, the hemodialysis rate stood at 62.7% for males vs. 84.1% for females.

Conclusions:

Females manifested a higher prevalence of high-grade histopathology, extended durations of hemodialysis, and increased incidences of established hemodialysis, culminating in inferior outcomes in both NMIBC and MIBC and augmented costs. The influence of hemodialysis and the CIS stage necessitates emphasis, underscoring the need for vigilant monitoring and immediate, assertive treatments.