Racial Differences In Survival Research Articles

Use of androgen deprivation therapy for metastatic prostate cancer in older men.

To assess factors associated with early or delayed androgen deprivation therapy (ADT) among men diagnosed with metastatic prostate cancer, and to assess the relationship between ADT and overall survival, as there is uncertainty about the ideal timing for initiating ADT in men with metastatic prostate cancer. We studied a population-based cohort of American men aged >or=66 years diagnosed with metastatic prostate cancer during 1992-2002 and followed to 2003. We assessed the receipt of ADT early (<or=4 months from diagnosis), delayed (>4 months), or not at all, using multinomial logistic regression to identify factors associated with treatment, and Cox proportional-hazard models to assess whether treatment was associated with survival. Overall, 69.5% of men received early ADT and 7.3% delayed. Adjusted rates of early ADT were lower for black than white men (58.3% vs 71.0%), and of delayed ADT were higher for black than white men (12.7% vs 6.2%). Receipt of ADT was associated with improved survival (adjusted hazard ratio 0.69, 95% confidence interval 0.66-0.73). The benefit of early treatment did not differ from delayed treatment (P = 0.58). A large minority of men with metastatic prostate cancer, particularly black men, receive delayed or no ADT. Early or delayed ADT was associated with similarly prolonged survival. After controlling for patient and tumour characteristics, survival did not differ by race, and receipt of ADT did not contribute to racial differences in survival.

Racial Disparities in Esophageal Cancer Treatment and Outcomes

Blacks have a higher mortality rate than whites from esophageal cancer, but the reasons underlying this disparity remain unclear. In this study, we used a national sample of patients with resectable esophageal cancer to assess the extent to which racial inequalities in care can explain outcome disparities. We identified all non-Hispanic white and black patients diagnosed with T0-T2, node-negative esophageal cancer between 1988 and 2003 from the Surveillance, Epidemiology, and End Results registry. Racial differences in esophageal-specific survival were assessed using the Kaplan-Meier method. We performed Cox regression to test for racial differences in survival after adjusting for potential confounders and to assess the extent to which disparities can be explained by later diagnosis or treatment inequalities. A total of 1522 patients were included in the study. Blacks had worse esophageal-specific survival rates than whites (37% vs 60% 5-year survival; P < .0001). Blacks were more likely to be diagnosed at a more advanced stage and to have squamous cell tumors, but were less likely to undergo surgery. In multivariate regression controlling for age, sex, marital status, histology, and tumor location, black race was associated with worse survival. When tumor status, surgery, and radiotherapy were added to the model, race was no longer significantly associated with survival. These data suggest that blacks are at greater risk of death from esophageal cancer. While the disparity is due in part to differences in tumor histology, diagnosis at an earlier stage and higher rates of surgery among blacks could reduce this survival disparity.

Survival after liver transplantation: Is racial disparity inevitable?

Previous analyses have reported that minority patients undergoing orthotopic liver transplantation (OLT) have poorer survival than Caucasian recipients. The reason for this disparity is unclear. We examined whether racial differences in survival exist at select academic OLT centers. OLT recipients from 4 academic centers were prospectively enrolled in 2 multicenter databases. Data including demographics, liver disease diagnosis, and post-OLT follow-up were obtained for 2823 (135 African, 2448 Caucasian, and 240 other race) adult patients undergoing primary OLT between 1985 and 2000. The survival of patients and grafts after OLT was compared across race. The Kaplan-Meier estimates for 1-year recipient survival were 90.8% [95% confidence interval (CI): 86.0-95.9] for African Americans, 86.5% (95% CI: 85.1-87.9) for Caucasians, and 84.4% (95% CI: 79.8-89.2) for other races. The 5-year recipient survival probability was 69.2% (95% CI: 60.1-79.7) for African Americans, 72.2% (95% CI: 70.1-74.4) for Caucasians, and 67.5% (95% CI: 60.5-75.3) for other races. The 10-year recipient survival probability for African Americans was 54.4% (95% CI: 41.1-72.1), for Caucasians 50.7% (95% CI: 46.4-55.3), and for other races 55.7% (95% CI: 41.5-74.8). There was no difference in patient survival (P = 0.162) or graft survival (P = 0.582) among racial groups. A multivariable proportional hazards model confirmed the absence of an association between race and post-OLT survival after adjustments for age, gender, total bilirubin, creatinine, prothrombin time, and diagnosis. These data demonstrate that as a proof of principle, minority OLT recipients should not necessarily expect an OLT outcome inferior to that of Caucasians.

Racial Differences in Cervical Cancer Survival in the Detroit Metropolitan Area

Purpose African American (AA) women have lower survival rates for cervical cancer when compared with white women. The purpose of this study was to examine the influence of socioeconomic status (SES) on disparities in overall survival among women with cervical cancer. Methods 1036 women (705 white and 331 AA) with a primary invasive cancer of the cervix were identified from the 1988 to 1992 Detroit SEER database. SES proxy was determined using occupation, poverty status, and educational level at the census-block level. Women were then assigned to one of four SES groups. Chi-square statistics were used to compare demographic, clinical characteristics and treatment modalities. A multivariable Cox model and Kaplan-Meier survival curves were used to compare survival rates between the two races. Results AA women were less likely to present with less severe disease (p Conclusions Patient age at diagnosis, stage, treatment, and SES all influence racial differences in survival among women with cervical cancer. When adjusted for these variables, AA and white women have similar overall survival rates.

The impact of race on outcome of autologous transplantation in patients with multiple myeloma

17029 Background: Multiple myeloma (MM) is the most common hematologic malignancy in African-Americans (AA), with historically double the mortality of Caucasians (C). Monoclonal gammopathy of undetermined significance (MGUS) is also three times more frequent in AA than C. There has been limited data exploring racial differences in survival during the era of high dose chemotherapy with autologous stem cell transplantation (ASCT). Methods: We retrospectively analyzed the records of all C (n=55) and AA (n=36) MM patients who underwent ASCT over 10 years. Presenting demographic, clinical features and response to therapy by the Bladé criteria were obtained from medical records. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method, and compared using the log-rank test. Results: The median age at diagnosis for AA was 52 years (30–75 years), compared to C at 56 years (39–79 years), p=0.006. There was no statistical difference in presenting ISS stage (AA: I- 50%, II- 28.1%, III- 21.9%; C: I- 51.2%, II- 20.9%, III- 27.9%), or values for presenting hemoglobin, calcium, and creatinine. There was a trend for increased skeletal involvement at diagnosis in the C group (82% vs. 69%, p=0.08). AA presented with an increased CRP (1.2 mg/dl vs. 0.25mg/dl, p=0.05). The most commonly used induction and conditioning regimen was VAD (78% AA vs. 70% C), and Mel 200 (72% AA vs. 65% C), respectively. Response to induction: CR: AA- 6%, C- 5%, p=1.00; PR: AA- 64%, C- 56%, p=0.519. Response to ASCT: CR: AA- 17%, C- 26%, p=0.438; PR: AA- 56%, C- 46%, p=0.519. At a median follow-up of 46.7 months, PFS was 60.5 months and 43.7 months (p=0.490), for AA and C, respectively; OS was 95.2 months and 68.5 months (p=0.421), for AA and C, respectively. Conclusion: In this series, AA with MM present at a younger age, with an increased CRP and a trend for less skeletal involvement than C at diagnosis. Despite a trend for less CR rates in AA, there was a trend for increased PFS and OS compared to C. This suggests there are biologic differences in MM between the races that may result in different therapeutic outcomes. One possible explanation would be the known higher frequency of MGUS in AA resulting in a reversion to a stable, indolent MGUS-like state after ASCT. These findings should be confirmed in larger studies. No significant financial relationships to disclose.

Racial Differences in Survival of Hepatocellular Carcinoma in the United States: A Population-Based Study

Racial Differences in Survival of Hepatocellular Carcinoma in the United States: A Population-Based StudyClinical Gastroenterology and HepatologyVol. 4Issue 1PreviewBackground & Aims: Survival after hepatocellular carcinoma (HCC) diagnosis is generally dismal, but there are patients with more favorable outcomes. Racial variation in survival of patients with HCC could be associated with observed differences in survival; however this has not been previously examined. Methods: During 1987–2001, HCC patients were identified from 9 Surveillance, Epidemiology, and End-Results registries. One- and 3-year survival rates were calculated and compared by race. Models were constructed to examine the effects of race on the mortality risk. Full-Text PDF

Racial Differences in Survival of Hepatocellular Carcinoma in the United States: A Population-Based Study

Survival after hepatocellular carcinoma (HCC) diagnosis is generally dismal, but there are patients with more favorable outcomes. Racial variation in survival of patients with HCC could be associated with observed differences in survival; however this has not been previously examined. During 1987-2001, HCC patients were identified from 9 Surveillance, Epidemiology, and End-Results registries. One- and 3-year survival rates were calculated and compared by race. Models were constructed to examine the effects of race on the mortality risk. Asians had the highest 1- and 3-year observed and relative survival, followed by whites, Hispanics, and blacks. Compared with whites, Asians (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.11-1.69) were more likely to receive local or surgical therapy, whereas blacks (OR, 0.62; 95% CI, 0.49-0.78) and Hispanics (OR, 0.81; 95% CI, 0.60-1.09) were less likely to receive therapy. Adjusting for differences in receipt of therapy, stage of HCC, year of diagnosis, and other demographics, Asians (hazard rate [HR], 0.84; 95% CI, 0.78-0.91) maintained a lower mortality risk compared with whites. In adjusted models, Hispanics (HR, 1.13; 95% CI, 1.03-1.24) maintained a higher mortality risk, whereas the mortality risk for blacks became nonsignificant different from whites (HR, 1.06; 95% CI, 0.99-1.14). Last, a 22% improvement in survival was observed between 1987-1991 and 1997-2001, which was mostly explained by increased receipt of local or surgical therapy. We observed significant racial variation in survival. These variations in survival are partly explained by a lower likelihood of receipt of therapy and more advanced HCC at diagnosis among blacks and Hispanics.

Pediatric brain tumors in Non-Hispanics, Hispanics, African Americans and Asians: differences in survival after diagnosis

Racial differences in survival for children with brain tumors have not been well studied, particularly in Hispanics and Asians. The objective of this study was to assess racial differences in survival of children with brain tumors, focusing on Hispanics, African Americans and Asians compared to Non-Hispanics. Subjects identified through the SEER Program were 2799 children, < or =19 years old at diagnosis, newly diagnosed between 1973 and 1996 with primary, malignant brain tumors. Chi-square tests were used to evaluate prognostic variables by race. Kaplan-Meier models and Cox proportional hazards models were used to assess racial differences in overall survival and in survival by histological type of tumor. The distribution histological type of tumor varied significantly by race. Overall survival was similar for Hispanics, African Americans, Asians compared to Non-Hispanics, although trends of increased risk of death for the minority groups were noted when stratifying by histological type of tumor. Racial differences in survival could exist by histological type of tumor, but further work is necessary for a more complete understanding of these differences.

Racial Differences in Survival after Acute Myocardial Infarction According to Kidney Function

Racial Differences in Survival after Acute Myocardial Infarction According to Kidney Function

Racial differences in survival based on tumor differentiation and stage in patients who have undergone surgery for colon cancer

3609 Background: In the United States, studies indicate that African-Americans have poorer survival compared to Caucasians after diagnosis of colonic adenocarcinoma (CAC). In this study, we evaluated differences in survival based on pathologic stage and histologic grade of the tumor, between African-Americans and Caucasians who have undergone surgical resection as their only treatment for CAC. Methods: All 169 African-Americans and 229 randomly selected non-Hispanic Caucasians who underwent surgery between 1981–1993 for first primary sporadic CAC at the University of Alabama at Birmingham and affiliated Veterans Affairs Hospitals were included. We evaluated differences in survival by tumor stage and within each histologic grade of the tumor. None of these patients received pre- or post- surgery adjuvant therapies. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI), adjusting for demographic and tumor characteristics. Results: Analysis based on tumor stage revealed disparity in survival between African-American and Caucasian patients within stage II, III, and IV CAC; however, this association was statistically significant only in stage II patients. Among patients with stage II CAC, African-Americans have a 2.53 (95% CI: 1.31, 4.86) times greater risk of death from CAC within five years after surgery, compared to Caucasians. Among patients with poorly differentiated tumors, African-Americans are 3.1 (95% CI: 1.4, 7.1) times more likely to die from CAC at any given point in time after surgical resection, compared to Caucasians. There were no statistically significant differences in survival between African-Americans and Caucasians with moderate or well differentiated tumors. Conclusions: Our findings suggest that decreased survival among African-Americans may not be attributable to under-staging at diagnosis or disparate treatment options, but may be due to differences in biologic features like degree of differentiation or other genetic abnormalities between these two ethnic groups of CAC patients who have undergone surgery. No significant financial relationships to disclose.

Racial differences in survival based on tumor differentiation and stage in patients who have undergone surgery for colon cancer

3609 Background: In the United States, studies indicate that African-Americans have poorer survival compared to Caucasians after diagnosis of colonic adenocarcinoma (CAC). In this study, we evaluated differences in survival based on pathologic stage and histologic grade of the tumor, between African-Americans and Caucasians who have undergone surgical resection as their only treatment for CAC. Methods: All 169 African-Americans and 229 randomly selected non-Hispanic Caucasians who underwent surgery between 1981–1993 for first primary sporadic CAC at the University of Alabama at Birmingham and affiliated Veterans Affairs Hospitals were included. We evaluated differences in survival by tumor stage and within each histologic grade of the tumor. None of these patients received pre- or post- surgery adjuvant therapies. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI), adjusting for demographic and tumor characteristics. Results: Analysis based on tumor stage revealed disparity in survival between African-American and Caucasian patients within stage II, III, and IV CAC; however, this association was statistically significant only in stage II patients. Among patients with stage II CAC, African-Americans have a 2.53 (95% CI: 1.31, 4.86) times greater risk of death from CAC within five years after surgery, compared to Caucasians. Among patients with poorly differentiated tumors, African-Americans are 3.1 (95% CI: 1.4, 7.1) times more likely to die from CAC at any given point in time after surgical resection, compared to Caucasians. There were no statistically significant differences in survival between African-Americans and Caucasians with moderate or well differentiated tumors. Conclusions: Our findings suggest that decreased survival among African-Americans may not be attributable to under-staging at diagnosis or disparate treatment options, but may be due to differences in biologic features like degree of differentiation or other genetic abnormalities between these two ethnic groups of CAC patients who have undergone surgery. No significant financial relationships to disclose.

Racial differences in survival among men with prostate cancer and comorbidity at time of diagnosis.

This study evaluated the effect of comorbidity at diagnosis on racial differences in survival among men with prostate cancer. Clinical and demographic data were abstracted from records of 864 patients diagnosed at 4 Chicago area hospitals between 1986 and 1990. Comorbidity was scored on the basis of clinical information in the Charlson index. Cause-specific relative mortality adjusted for age, stage, differentiation, and treatment was compared across Charlson scores with Cox proportional hazards functions. Blacks had significantly greater mortality from prostate cancer and other causes (vs Whites, relative risk [95% confidence interval] = 1.84 [1.22, 2.79] and 1.69 [1.33, 2.29], respectively; P <.001). However, differences disappeared as initial comorbidity increased (1.75 [1.33, 2.31] vs 0.90 [0.59, 1.29] for scores = 0 and > or =5, respectively). Absence of a significant preexisting medical diagnosis is associated with a higher risk for excess mortality among Black men diagnosed with prostate cancer.

Surveillance, Epidemiology, and End Results analysis of 2677 cases of uterine sarcoma 1989–1999

Objective. To determine the association of race with incidence, histology, treatment, and survival in women with uterine sarcoma during the period 1989–1999. Methods. Uterine sarcomas were defined as leiomyosarcoma, carcinosarcoma, high-grade endometrial stromal sarcoma (HGESS), adenosarcoma, and sarcoma not otherwise specified (NOS). We used cases from Surveillance, Epidemiology, and End Results (SEER) program to compare uterine sarcoma among women >35 years of age. Using data from 1989 to 1999, we compared race-specific age-adjusted incidences, histological distributions, extent of disease at diagnosis, and race-specific survival. Results. During the period of 1989–1999, 2677 women were diagnosed with uterine sarcoma, 2098 (78%) of whom were white and 420 (16%) of whom were black, and 159 (6%) of whom were of other races. The overall age-adjusted incidence for blacks was twice that of whites and more than twice that of women of other races (7/10 5 vs. 3.6/10 5 vs. 2.7/10 5, P < 0.0001). Racial differences in the incidence of uterine sarcoma existed for leiomyosarcoma (1.51/10 5 for blacks vs. 0.91/10 5 for whites, and 0.89 for women of other races, P < 0.01) and carcinosarcoma (4.3/10 5 for blacks, vs. 1.7/10 5 for whites, and 0.99 for women of other races, P < 0.001), but not for other histological types. Blacks with stage II disease were less likely to receive radiation in addition to surgery compared to whites (33% vs. 54%, P < 0.05). Five-year relative survival of patients with disease beyond the uterus was significantly longer for those that received radiation and surgery compared to those that received surgery alone. There were no racial differences in survival for women that received similar therapy. Conclusions. Adjuvant therapy improved survival for women with stage II–IV disease. Survival of black and white patients who received comparable treatment was similar.

Influence of race and socioeconomic status on outcome of children treated for childhood acute lymphoblastic leukemia.

Overall, childhood acute lymphoblastic leukemia is associated with an excellent outcome. The improvement in survival achieved during the last three decades is partially attributed to the identification of risk factors predicting a poor outcome and risk-stratified treatment of patients placed on well-designed therapeutic trials. Accordingly, it is important to continue to identify patient subgroups with differences in outcome to focus efforts to improve overall survival. Black children historically have been reported to have a poorer survival rate compared with whites, but limited information is available for children from other racial/ethnic backgrounds. Several groups have published reports on ethnic and racial differences in survival after childhood acute lymphoblastic leukemia, with poorer outcomes reported for black children compared with whites reported by the majority of the studies. Limited information is available for children from other racial/ethnic backgrounds, such as Hispanics and Asians, but data indicate that Hispanics have poorer survival than whites, whereas Asians from the United States have outcomes that are as good or better than those of the whites, especially among the high-risk group treated with contemporary risk-based therapy. The influence of race and ethnicity on survival should be closely linked with socioeconomic status. However, few studies have specifically investigated the influence of nutrition and socioeconomic factors on the prognosis of children with acute lymphoblastic leukemia, and the results are conflicting. Future studies need to focus on the reasons for these differences, including racial and ethnic differences in adherence with therapeutic protocols, and ethnic differences in drug metabolism and bioavailability of the agents commonly used in acute lymphoblastic leukemia, so that drug administration can be modified if needed.

Is there any racial difference in survival of patients with fulminant hepatic failure?

Is there any racial difference in survival of patients with fulminant hepatic failure?

Is there any racial difference in survival of patients with fulminant hepatic failure?

Is there any racial difference in survival of patients with fulminant hepatic failure?

Racial differences in survival of patients on dialysis

Recent studies have documented racial differences in the crude mortality rates of patients on dialysis. However, proper interpretation of these findings requires adjustment for potential confounders and comorbid risk factors between the racial groups. We examined the clinical data on 3752 Caucasian patients, 451 Southeast Asian patients, 322 South Asian patients, and 319 black patients who were treated with hemodialysis or peritoneal dialysis under a Universal Health Care system in Toronto and prospectively followed between 1981 and 1995. In all patients, a number of comorbid risk factors for survival was assessed at the start of dialysis and was reassessed with their outcome status (that is, continued dialysis, transplantation, death, or loss to follow-up) at least every six months. Cox proportional hazards analysis was used to fit multivariate models predicting patient survival. Pairwise comparisons of the relative hazards of death between the racial groups were performed after stratifying for cardiovascular disease, diabetes mellitus, and hypertension at the start of dialysis, and were adjusted for differences in other comorbid risk factors. The risk of death in Caucasian patients was significantly increased when compared with Southeast Asian patients, South Asian patients, and black patients [multivariate relative hazards (95% CI): 1.63 (1.36 to 1.97), 1.36 (1.07 to 1.73), 1.34 (1.07 to 1.67), respectively]. Additionally, we detected an interaction between race and cigarette smoking (P < 0. 004), suggesting that in the dialysis patients who smoked, whites had a higher mortality risk compared with non-whites. Differences in patient survival on dialysis exist between racial groups. However, the genetic and environmental determinants that underlie these differences are presently unknown.

Differences in socioeconomic status and survival among white and black men with prostate cancer.

After diagnosis with prostate cancer, Black men in the United States have poorer survival than White men, even after controlling for differences in cancer stage. The extent to which these racial survival differences are due to biologic versus non-biologic factors is unclear, and it has been hypothesized that differences associated with socioeconomic status (SES) might account for much of the observed survival difference. The authors examined this hypothesis in a cohort study, using cancer registry and US Census data for White and Black men with incident prostate cancer (n = 23,334) who resided in 1,005 census tracts in the San Francisco Bay Area during 1973-1993. Separate analyses were conducted using two endpoints: death from prostate cancer and death from other causes. For each endpoint, death rate ratios (Blacks vs. Whites) were computed for men diagnosed at ages <65 years and at ages > or =65 years. These data suggest that differences associated with SES do not explain why Black men die from prostate cancer at a higher rate when compared with White men with this condition. However, among men with prostate cancer, SES-associated differences appear to explain almost all of the racial difference in risk of death from other causes.

RACE AND CAUSE SPECIFIC SURVIVAL WITH PROSTATE CANCER: INFLUENCE OF CLINICAL STAGE, GLEASON SCORE, AGE AND TREATMENT

We assess the influence of race on stage stratified cause specific survival of men with prostate cancer, and Gleason score, age at diagnosis and treatment on potential racial differences in survival. A total of 524 black and 396 white men were diagnosed with prostate cancer at a Veterans Affairs Medical Center between January 1982 and December 1992. Clinical stage was determined by retrospective review of the medical records and Gleason score of biopsy material as assigned by a single uropathologist. Of 611 patients who died the cause of death was determined by retrospective or prospective review of hospital records in 493 and by review of the death certificates in 102. In 16 cases the cause of death was indeterminate. Median potential followup was 112 months (range 60 to 182) and median period of observation was 61 months (range 1 to 182). Cause specific survival with stage T1b-2 cancer was lower in 231 black than in 264 white men of all ages (p = 0.02) and lower in 110 black than in 170 white men younger than in 70 years at diagnosis (p = 0.04). Gleason 7 to 10 cancer, which was associated with a less favorable cause specific survival compared to Gleason 2 to 6 cancer (p <0.0001), was more common in black than in white men with stage T1b-2 cancer of all ages (p = 0.01) and younger than 70 years at diagnosis (p = 0.04). No or unknown treatment status, which was associated with a less favorable cause specific survival compared to treatment (p = 0.05), was more common in black than in white men with stage T1b-2 cancer of all ages (p = 0.0005) but not significantly different when stratified by age. In men of all ages racial differences in cause specific survival were not significant when adjusted for age and Gleason score (p = 0.14) or age, Gleason score and treatment status (p = 0.17). In men younger than 70 years racial differences in cause specific survival were not significant when adjusted for age and Gleason score (p = 0.22). There were no significant racial differences in overall or age stratified all cause survival of men with stage T1b-2 cancer. There were no significant differences in overall or age stratified cause specific or all cause survival of 112 black and 58 white men with stage T3-4 cancer, or 181 and 74, respectively, with metastatic cancer. Our data indicate that local stage prostate cancer is more lethal in black than in white men and the difference is most pronounced in men younger than 70 years. The survival disadvantage of black men with local stage cancer is due in part to a propensity for development of less differentiated and more aggressive malignancies.

Differences in cervical cancer mortality among black and white women

Objective: To determine whether stage of disease and treatment patterns account for mortality differences between black and white women with cervical cancer. Methods: Using data obtained from the Surveillance, Epidemiology, and End Results (SEER) Program for 1988–1994, we determined the associations between race and stage, and race and treatment. Racial differences in survival for up to 7 years of follow-up were adjusted for age, marital status, SEER location, International Federation of Gynecology and Obstetrics (FIGO) stage of disease, lymph node status, grade, histology, and treatment. Results: Cumulative mortality was 36% (366 deaths in 1029 women) for black women and 24% (1215 deaths in 5021 women) for white women; unadjusted hazard ratio was 1.60 (95% confidence interval [CI] 1.43, 1.80). Black women were more likely to present with advanced disease than white women (43.8% compared with 34.8%). In a model adjusting for demographics and FIGO stage, the hazard ratio for black women compared with white women decreased to 1.35 (95% CI 1.19, 1.54). Treatment varied by race, with black women receiving surgery less often (33.5% compared with 48.2%, respectively) and radiation therapy more often (35.3% and 25.2%, respectively) than white women. In a comprehensive model including demographic factors, FIGO stage, other tumor characteristics, and treatment, the adjusted hazard ratio for mortality remained high for black women at 1.30 (95% CI 1.14, 1.48). Conclusion: Race remains an independent predictor of cervical cancer survival after accounting for age, stage of disease, treatment patterns, and other factors. Future studies should assess racial differences in clinical severity of disease, comorbidity, and socioeconomic status.