Sex disparities in bladder cancer diagnosis: evidence from the UK Biobank

To evaluate sex- and age-specific differences in the predictive value of hematuria and urinary tract infections (UTIs) for bladder cancer, and their association with disease invasiveness and mortality. We analyzed 4,848 bladder cancer cases and matched controls from the UK Biobank cohort. Logistic regression with Firth penalization was used to assess hematuria and UTIs as predictors of bladder cancer across sex and age groups (< 50, 50–64, and ≥ 65 years). Secondary analyses evaluated associations with tumor invasiveness and all-cause mortality among cases. Hematuria was the strongest and most consistent predictor of bladder cancer across all groups, with odds ratios ranging from 5.42 (older males) to 56.32 (females under 50). UTIs were predictive in all female age groups—most strongly under age 50, and in males under 50, but not in older populations. Hematuria was inversely associated with invasive disease in selected subgroups. UTIs were linked to increased mortality among patients aged ≥ 65. Our findings highlight sex- and age-specific disparities in early bladder cancer symptomatology. UTIs, often attributed to benign conditions, may represent an overlooked early manifestation of bladder cancer in women and younger men. Recognizing these patterns may support earlier diagnosis and reduce sex-related diagnostic delays.