Abstract 1898: Racial/ethnic disparities in stage at diagnosis among women with cervical cancer in Texas: Mediating effects of neighborhood-level socioeconomic deprivation

Abstract

Abstract Background: Although mortality from cervical cancer has declined steadily in the U.S. since the advent of population-based screening in the 1970s, the benefit has not reached all racial/ethnic groups of patients equally. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and being diagnosed with late-stage versus early-stage cervical cancer. Methods: We analyzed Texas Cancer Registry data for cervical cancer cases diagnosed among women aged 18 or older from 2010 to 2018. Cervical cancer cases were categorized as early or late stage at diagnosis. First, we used a stepwise hierarchical logistic regression model to examine the associations between race/ethnicity and stage at diagnosis. Then, we performed causal mediation analyses using the counterfactual framework approach to estimate the direct, indirect (mediated), and total effects, and percent mediated. Results: Of the 9525 women with cervical cancer, 4869 (2200 non-Hispanic White (NHW) (45.2%), 720 non-Hispanic Black (NHB) (14.8%), 1800 Hispanic (37.0%)) had late-stage cervical cancer at diagnosis (overall, 51.1%). Women 65 years or older, NHB, Hispanic, with Medicaid/Medicare, uninsured, and those who reside in more deprived neighborhoods were more likely to present with advanced cervical cancer at diagnosis (p <0.001). Compared to NHW women (11.8%), NHB (28.5%) and Hispanic (34.4%) women were more likely to live in most deprived neighborhoods and had greater odds of late-stage cervical cancer diagnosis (unadjusted odds ratios 1.49 (95% CI 1.31-1.69) and 1.20 (95% CI 1.10-1.31), respectively). In the age-adjusted mediation analysis, 23.1% and 52.2% of the disparity were attributable to higher disadvantages among NHB and Hispanic women, respectively.Conclusions: Results of mediation analyses suggested that area-level deprivation explained some of the racial/ethnic disparities in stage at diagnosis of cervical cancer among NHB and Hispanic women versus NHW women.Impact: These findings can be applied to develop targeted and race-specific interventions to improve early diagnosis and treatment of cervical cancer for cancer care equity. Citation Format: Itunu O. Sokale, Abiodun O. Oluyomi, Aaron P. Thrift. Racial/ethnic disparities in stage at diagnosis among women with cervical cancer in Texas: Mediating effects of neighborhood-level socioeconomic deprivation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1898.