The effect of neighborhood disadvantage on the racial disparity in ovarian cancer-specific survival in a large hospital-based study in cook county, illinois.

Marian L Fitzgibbon,Sally Freels,Charlotte E Joslin,Caryn E Peterson,Timothy P Johnson,Garth H Rauscher,Carolyn V Kirschner,Richard E Barrett,Seijeoung Kim,Faith G Davis

doi:10.3389/fpubh.2015.00008

Abstract

This paper examines the effect of neighborhood disadvantage on racial disparities in ovarian cancer-specific survival. Despite treatment advances for ovarian cancer, survival remains shorter for African-American compared to White women. Neighborhood disadvantage is implicated in racial disparities across a variety of health outcomes and may contribute to racial disparities in ovarian cancer-specific survival. Data were obtained from 581 women (100 African-American and 481 White) diagnosed with epithelial ovarian cancer between June 1, 1994, and December 31, 1998 in Cook County, IL, USA, which includes the city of Chicago. Neighborhood disadvantage score at the time of diagnosis was calculated for each woman based on Browning and Cagney’s index of concentrated disadvantage. Cox proportional hazard models measured the association of self-identified African-American race with ovarian cancer-specific survival after adjusting for age, tumor characteristics, surgical debulking, and neighborhood disadvantage. There was a statistically significant negative association (−0.645) between ovarian cancer-specific survival and neighborhood disadvantage (p = 0.008). After adjusting for age and tumor characteristics, African-American women were more likely than Whites to die of ovarian cancer (HR = 1.59, p = 0.003). After accounting for neighborhood disadvantage, this risk was attenuated (HR = 1.32, p = 0.10). These findings demonstrate that neighborhood disadvantage is associated with ovarian cancer-specific survival and may contribute to the racial disparity in survival.

Highlights

Ovarian cancer is the fifth leading cause of cancer death among U.S women, with an estimated 21,980 new cases diagnosed in 2014 and 14,270 deaths [1]
Recent SEER data show improvements in the 5-year relative survival for women diagnosed with ovarian cancer, yet these rates remain significantly lower for African-American women compared to Whites (36 and 44%, respectively) [1]
Using Browning and Cagney’s [25] index of concentrated disadvantage, we examined whether neighborhood disadvantage was associated with cancer-specific survival, and whether this association helped to explain any observed survival disparity among African-American and White women diagnosed with ovarian cancer in Cook County, IL, USA, which includes the city of Chicago

Summary

Introduction

Ovarian cancer is the fifth leading cause of cancer death among U.S women, with an estimated 21,980 new cases diagnosed in 2014 and 14,270 deaths [1]. Racial differences in individual-level demographic and clinical factors play an important role in prolonging or shortening survival following diagnosis of various types of cancer [8,9,10]. These individuallevel differences may be due in part to differences in neighborhood environments, and excluding this important contextual factor may produce an incomplete picture. This analysis explores the role that neighborhood, and in particular neighborhood disadvantage, plays in explaining the racial disparity in ovarian cancer survival

Methods

Results

Conclusion