Race and education differences in intentions to seek care for gross hematuria: Implications for timely diagnosis of bladder cancer

Background: Bladder Cancer is the fifth most common cancer in the United States, with an estimated 70,530 new cases in 2010. Delay in diagnosis is associated with decreased survival. To identify the causes of delay in diagnosis we need to better understand patterns of care seeking for gross hematuria, the most common sign of the disease. A survey study was conducted to identify characteristics associated with intentions to delay seeking medical care and ascertain where people intend to seek care for gross hematuria. Methods: The survey was administered to a convenience sample of 611 men and women forty years and older recruited from shopping malls in five metropolitan areas. The final dataset included 576 respondents that were 29% Black, 43% female, 56% not married, with a mean age of 54 (SE = 0.48). Two multivariate logistic models were tested. In the first model, the outcome of interest was whether participants intended to delay seeking care or immediately seek care. In the second, the outcome of interest was whether participants intended to seek care from “your doctor” or an emergency room. Results: Although most people intended to promptly seek care if they noticed blood in their urine, in the adjusted model having less than a high school education, compared to some college or greater, was associated with greater odds of intending to delay seeking care (OR 4.67, 95% 1.54, 14.13). Black, compared to white race (OR 2.56, 95% CI 1.69, 3.89), and not being married compared to being married (OR 1.69, 95% CI 1.13, 2.55) were associated with increased odds of intending to seek care from an emergency room rather than one's doctor. Conclusions: Multiple approaches may be useful for improving the efficiency with which bladder cancer is diagnosed. Public health education tailored to low-education and/or low health literacy audiences is needed to encourage early and appropriate response to bladder cancer symptoms. Also, blacks and respondents who were not married reported a relatively greater intention to utilize the emergency room. A process delay in urologic referral from an urgent or emergent care unit might be contributing to the known disparities in stage at diagnosis, and ultimately disparities in survival seen in these populations. If not already in place, emergency departments, as well as primary care facilities, need to have procedures for efficiently referring patients who present with gross hematuria to urologists for evaluation for bladder cancer.