abstract
PURPOSE:
Despite
significant improvements in treatment for ovarian cancer, survival is
poorer for non-Hispanic black (NHB) women compared to non-Hispanic white
(NHW) women.
Neighborhood socioeconomic status (SES) has been
implicated in racial disparities across a variety of health outcomes and
may similarly contribute to racial disparities in ovarian cancer
survival. The purpose of this analysis is to assess the influence of
neighborhood SES on NHB-NHW survival differences after accounting for
differences in tumor characteristics and in treatment.
METHODS:
Data
were obtained from 2432 women (443 NHB and 1989 NHW) diagnosed with
epithelial ovarian cancer in Cook County,
Illinois between 1998 and
2007. Neighborhood (i.e., census tract) SES at the time of diagnosis was
calculated for each woman using two well-established composite measures
of affluence and disadvantage. Cox proportional hazard models measured
the association between NHB race and survival after adjusting for age,
tumor characteristics, treatment, year of diagnosis, and neighborhood
SES.
RESULTS:
There
was a strong association between ovarian cancer survival and both
measures of neighborhood SES (P < .0001 for both affluence and
disadvantage). After adjusting for age, tumor characteristics,
treatment, and year of diagnosis,
NHB were more likely than NHW to die
of ovarian cancer (hazard ratio [HR] = 1.47, 95% confidence interval
[CI]: 1.28-1.68). The inclusion of neighborhood affluence and
disadvantage into models separately and together attenuated this risk
(HR
affluence = 1.37, 95% CI: 1.18-1.58; HR
disadvantage = 1.28, 95% CI: 1.08-1.52; and HR
affluence + disadvantage = 1.28, 95% CI: 1.08-1.52.
CONCLUSIONS:
Neighborhood
SES, as measured by composite measures of affluence and disadvantage,
is a predictor of survival in women diagnosed with ovarian cancer in
Cook County, Illinois and may contribute to the racial disparity in
survival.
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