Abstract
BackgroundThe 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.MethodsData 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.ResultsAmong 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.ConclusionRacial disparities in availability and utilization of healthcare resources likely contributes to adverse epithelial ovarian cancer outcomes among Black women in the US.
Highlights
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
Black patients were more likely to reside in counties with a higher proportion of families living below the poverty level (43.0% vs. 22.8%, p-value: < 0.0001) compared with White patients
We observed that accounting for these differences, in addition to clinical and histologic variables, did not eliminate racial disparities in late stage diagnosis or mortality with epithelial ovarian cancer, even though timely diagnosis and highquality treatment of epithelial ovarian cancer are most likely dependent on specialty-trained surgeons and healthcare centers with multidisciplinary oncologic care and ultrasound equipment. [27, 28] We observed that among Blacks, residing in counties with fewer medical doctors doubled the odds of late stage diagnosis, none of the health care access (HCA) variables were independently associated with stage at diagnosis for Whites
Summary
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. Geographic access to healthcare and utilization of care in relation to cancer outcomes is a relatively understudied and highly complex area of disparities research. It is an essential factor for early diagnosis and receipt of high quality and timely treatment, elements critical for the survival of women with ovarian cancer. It is an essential factor for early diagnosis and receipt of high quality and timely treatment, elements critical for the survival of women with ovarian cancer. [11, 18] Prior studies have shown that the availability of healthcare resources has significant influence on health outcomes, including breast and colorectal cancer survival. [19,20,21] The influence of healthcare availability on health outcomes appears to vary by race; a higher number of medical personnel and health facilities in US counties was observed not to be significantly associated with reduced late stage presentation and longer survival for Black colorectal cancer patients, but was associated with improved outcomes for White colorectal cancer patients. [19, 21] Since Black women are more likely to present with late stage of disease and have higher mortality, despite lower ovarian cancer incidence compared with Whites, [22,23,24,25] examining if and how availability of healthcare resources influences ovarian cancer stage and mortality among Blacks and Whites may improve understanding of the causes of persistent racial disparities, while highlighting potential areas for targeted intervention strategies.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
