Wang Zhixin, Dilley Sarah, Park HyounKyoung G, Bartolucci Alfred A, Wang Chenguang, Huh Warner K, Bae Sejong
Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Division of Gynecology Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Cancer Health Disparities. 2019;3:e1-e12. Epub 2019 Aug 19.
The aim of this study was to investigate the association between geographic regions and ovarian cancer disparities in the United States. Data from the Surveillance, Epidemiology, and End Results (SEER) Program was used to identify women diagnosed with ovarian cancer. 18 registries were divided into two groups: South region and US14 region. Chi-Square tests were used to compare proportions, the logistic regression model to evaluate the association between 5-year survival and other variables, and the Cox proportional hazards model to estimate hazard ratios. The South region had a lower incidence rate than the US14 region (12.0 vs. 13.4 per 100,000), and a lower 5-year observed survival rate (37.5% vs. 39.8%). White women living in the US14 region had the best overall survival, compared to white women living in the South region, and black women living in both regions. Women in the South region were less likely to have insurance (6.6% vs. 2.7%, p<0.0001) and surgery (73.4% vs. 76.2%, p<0.0001). Women living in the South were 1.4 times more likely to die after five years of diagnosis than women living in the US14 region. The data confirmed regional disparities in ovarian cancer in the United States, showing women living in the South region were disadvantaged in ovarian cancer survival regardless of race, black or white. Future research focusing on the identification of contributing factors to regional disparity in ovarian cancer is necessary to develop practical approaches to improve health outcomes related to this lethal disease.
本研究的目的是调查美国地理区域与卵巢癌差异之间的关联。利用监测、流行病学和最终结果（SEER）计划的数据来识别被诊断为卵巢癌的女性。18个登记处被分为两组：南部地区和美国其他14个地区。使用卡方检验来比较比例，使用逻辑回归模型来评估5年生存率与其他变量之间的关联，使用Cox比例风险模型来估计风险比。南部地区的发病率低于美国其他14个地区（每10万人中分别为12.0例和13.4例），5年观察生存率也较低（37.5%对39.8%）。与居住在南部地区的白人女性以及居住在这两个地区的黑人女性相比，居住在美国其他14个地区的白人女性总体生存率最高。南部地区的女性拥有保险的可能性较小（6.6%对2.7%，p<0.0001），接受手术的可能性也较小（73.4%对76.2%，p<0.0001）。与居住在美国其他14个地区的女性相比，居住在南部的女性在诊断五年后死亡的可能性高出1.4倍。数据证实了美国卵巢癌存在地区差异，表明无论种族是黑人还是白人，居住在南部地区的女性在卵巢癌生存方面处于劣势。有必要开展未来研究，聚焦于确定导致卵巢癌地区差异的因素，以制定切实可行的方法来改善与这种致命疾病相关的健康结果。
