OBJECTIVES: Hematuria is a common symptom of urinary tract cancer (UTC). Having an easily identifiable symptom such as hematuria in the case of UTC may result in earlier diagnosis. This study aims to examine the association of hematuria with UTC and explore potential gender differences in its prevalence among bladder cancer patients in UK primary care.

METHODS: This is a retrospective case-control study using the Clinical Practice Data Link between January 2000 and December 2020. Cases of patients diagnosed with UTC were matched in a 1:4 ratio to controls (patients without UTC diagnosis) by year of birth, gender, and general practitioner practice. Index date for cases was date of UTC diagnosis and for controls index was imputed as the date of diagnosis for their matched case. The association between haematuria and UTC was estimated using conditional logistic regression (CLR) models.

RESULTS: A total of 9147 cases and 36,588 controls were included in the analysis. The mean age in both groups was 70.7 years and 73.3% of patients in each group were males. In the year prior to index date hematuria was present in 49.3% (4511/9147) of cases and 1.1% (400/36,588) of controls. Overall, the odds of hematuria presence were higher in cases vs. the controls in the unadjusted CLR model (Odds Ratio: 158; 95% CIs: 130.76,190.90, P <0.0001). This effect did not diminish in the adjusted model. The presence of hematuria was higher in the male cases (51.6%: 3458/6708) vs. the female cases (43.2%: 1053/2439) CONCLUSION: The findings of this study add to the well-established evidence base demonstrating hematuria is a strong prognostic factor of UTC. The lower observed prevalence of hematuria in females might be indicative of under detection of an important symptom of UTC in UK primary care.