Availability of Healthcare Resources and Ovarian Cancer Stage and Mortality Among Blacks and Whites

Authors:

Swati Sakhuja (Presenter)
University of Alabama at Birmingham School of Public Health

Huifeng Yun, University of Alabama at Birmingham School of Public Health
Maria Pisu, University of Alabama at Birmingham School of Medicine
Tomi Akinyemiju, University of Alabama at Birmingham School of Public Health

Public Health Statement: Ovarian cancer is the leading cause of death from gynecological malignancies in the US. Racial disparities in ovarian cancer survival persist even after vast improvements in treatment approaches.

Purpose: The purpose of this study is to examine whether racial disparities in ovarian cancer stage at diagnosis and mortality can be explained by availability of healthcare resources among Blacks and Whites.

Methods/Approach: Data from the Surveillance, Epidemiology and End Results (SEER) database was used and included non-Hispanic (NH) White and NH-Black women ages 40 years and above diagnosed with ovarian cancer between 2000 and 2010. Data on availability of healthcare (HCA) resources at the county level and socio-economic status (SES) were linked with individual data on cancer incidence, stage and mortality. Multi-level regression models were used to examine the association between HCA and SES on ovarian cancer stage at diagnosis while Cox proportional hazards models were used to examine the association with ovarian cancer survival. All models were also stratified by race/ethnicity and adjusted for socio-demographics and clinical variables.

Results: Among the 51,849 women with ovarian included in our analysis, NH-Blacks were more likely to be diagnosed at younger ages, had 20% higher odds for late stage diagnosis of ovarian cancer (OR: 1.21, 95% CI: 1.09–1.35) and a 37% higher risk of ovarian cancer mortality compared with NH-Whites (HR: 1.37, 95% CI: 1.30–1.43). NH-Blacks were more likely to reside in counties with fewer average number of oncology hospitals (7.1 v. 7.4, p-value<0.05) and hospitals with ultrasound (9.6 vs. 10.9, p-value <0.001), but higher number of medical doctors (1098 vs. 931, p-value <0.0001) and Obstetricians/Gynecologists (299 vs. 242, p-value <0.001). In race-stratified models, residing in counties with fewer medical doctors was associated with increased odds of late stage diagnosis in HCA only model (OR: 1.95, 95% CI: 1.11–3.43) and HCA and SES model (OR: 2.02, 95% CI: 1.15–3.55) for NH-Blacks.

Conclusions/Implications: Racial disparities in availability of healthcare resources and utilization of those resources likely influence adverse ovarian cancer outcomes observed among NH-Black women in the US.