Bladder Cancer in the United States: National Trends and State-Level Patterns from Global Burden of Disease (GBD) Study, 1980-2021

Background: The U.S. has the highest health care expenditure globally. Examining long-term national and state-level trends, and benchmarking them against other health systems, can provide important insights for public health planning and policy development. Aim: This study aimed to characterize temporal trends in the burden of bladder cancer, including prevalence, incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), and to evaluate state-level disparities and potential long-term effects of health policies. Methodology: Data were obtained from the Global Burden of Disease (GBD) 2021 study. Age- and sex-stratified trends were analyzed and visualized at both national and state levels across the study period. Burden estimates were additionally compared with those of other major health systems, including the European Union, countries with high socio-demographic index, and high-income settings. Results: In 2021, the U.S. recorded age-standardized rates of 8.35 for YLDs (0.33 lower), 3.41 for mortality (0.11 higher), 59.80 for YLLs (6.75 higher), 100.63 for prevalence (6.61 lower), 14.69 for incidence (0.51 lower), and 68.15 for DALYs (6.42 higher) compared to 1990 records. Lowest gender discrepancies across all measures were in 2021 were observed in District of Columbia with male:female ratio of DALYs: 2.4 [1.7, 3.2], mortality: 2.4 [1.8, 3.2], incidence: 2.5 [1.8, 3.4], prevalence: 2.4 [1.8, 3.2], YLDs: 2.4 [1.4, 4.1], and YLLs: 2.4 [1.7, 3.2]. In contrast, North and South Dakota had the highest gender discrepancies: DALYs: 3.9 [3.0, 5.2], incidence: 4.1 [3.1, 5.4], prevalence: 3.9 [3.0, 5.0], and YLLs: 4.0 [3.0, 5.2] and mortality: 4.2 [3.2, 5.6] and YLDs: 3.9 [2.3, 6.3]. Conclusion: Bladder cancer continues to impose a substantial and uneven burden across the U.S. State-level variations, driven by environmental factors, aging populations, and healthcare access gaps, require targeted prevention and improved early detection. Future research should assess the cost-effectiveness of prioritizing prevention over late-stage treatment to optimize healthcare spending.