Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Ovarian Res. 2017 Aug 22;10(1):57. doi: 10.1186/s13048-017-0352-1.
The purpose of this study is to examine whether racial disparities in epithelial ovarian cancer stage at diagnosis and survival may be explained by geographic availability of healthcare resources among Blacks and Whites.
Data from the Surveillance, Epidemiology and End Results (SEER) database was used to identify White and Black women ages 40 years and above diagnosed with epithelial ovarian cancer between 2000 and 2010. Data on county-level availability of healthcare resources was obtained from the Area Resource File. Multi-level regression models, overall and stratified by race and age, were used to examine the associations of health care access (HCA) and socioeconomic status (SES) with stage at diagnosis while Cox proportional hazards models were used to examine the association with survival.
Among 46,423 women diagnosed with epithelial ovarian cancer, Blacks were more likely to reside in counties with fewer average number of oncology hospitals (p < 0.05) and hospitals with ultrasound (p < 0.001), but higher number of medical doctors (p < 0.0001) and Ob/Gyn (p < 0.001). Black patients had higher odds of late stage diagnosis of epithelial ovarian cancer (OR: 1.13, 95% CI: 1.04-1.25) and higher risk of epithelial ovarian cancer mortality (HR: 1.25, 95% CI: 1.19-1.32) compared with White patients after accounting for differential availability of healthcare resources. Among Black patients, residing in counties with fewer medical doctors was associated with increased odds of late stage diagnosis (OR: 1.86, 95% CI: 1.10-3.13), and the racial disparity in late stage diagnosis and mortality was larger among patients ages <65 years compared with older patients.
Racial disparities in availability and utilization of healthcare resources likely contributes to adverse epithelial ovarian cancer outcomes among Black women in the US.
本研究旨在探讨黑人和白人在医疗保健资源的地域可及性方面是否存在上皮性卵巢癌诊断时的分期和生存方面的种族差异。
本研究使用监测、流行病学和最终结果（SEER）数据库的数据，确定了 2000 年至 2010 年间诊断为上皮性卵巢癌的年龄在 40 岁及以上的白人和黑人妇女。医疗保健资源县级可用性数据来自区域资源文件。使用多水平回归模型，对种族和年龄进行分层，检查卫生保健获取（HCA）和社会经济地位（SES）与诊断时分期的关联，同时使用 Cox 比例风险模型检查与生存的关联。
在诊断为上皮性卵巢癌的 46423 名女性中，黑人更有可能居住在平均肿瘤医院数量较少的县（p<0.05）和拥有超声设备的医院较少的县（p<0.001），但医生（p<0.0001）和妇产科医生（p<0.001）较多的县。在考虑到医疗保健资源的差异可用性后，与白人患者相比，黑人患者上皮性卵巢癌晚期诊断的可能性更高（OR：1.13，95%CI：1.04-1.25），上皮性卵巢癌死亡率更高（HR：1.25，95%CI：1.19-1.32）。在黑人患者中，居住在医生数量较少的县与晚期诊断的可能性增加相关（OR：1.86，95%CI：1.10-3.13），与年龄较大的患者相比，年龄<65 岁的患者的晚期诊断和死亡率的种族差异更大。
在美国，黑人和白人在医疗保健资源的可及性和利用方面的种族差异可能导致黑人女性上皮性卵巢癌结局不良。
