TY - JOUR
T1 - Survival disparities in non-Hispanic Black and White cervical cancer patients vary by histology and are largely explained by modifiable factors
AU - Kucera, Calen W.
AU - Chappell, Nicole P.
AU - Tian, Chunqiao
AU - Richardson, Michael T.
AU - Tarney, Christopher M.
AU - Hamilton, Chad A.
AU - Chan, John K.
AU - Kapp, Daniel S.
AU - Leath, Charles A.
AU - Casablanca, Yovanni
AU - Rojas, Christine
AU - Sitler, Collin A.
AU - Wenzel, Lari
AU - Klopp, Ann
AU - Jones, Nathaniel L.
AU - Rocconi, Rodney P.
AU - Farley, John H.
AU - O'Connor, Timothy D.
AU - Shriver, Craig D.
AU - Bateman, Nicholas W.
AU - Conrads, Thomas P.
AU - Phippen, Neil T.
AU - Maxwell, G. Larry
AU - Darcy, Kathleen M.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/5
Y1 - 2024/5
N2 - Purpose: We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities. Methods: Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC). Results: This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35–1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15–1.24 for SCC; HR = 2.32, 95% CI = 2.12–2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97–1.06) or AC (AHR = 1.09, 95% CI = 0.96–1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively). Conclusions: Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors.
AB - Purpose: We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities. Methods: Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC). Results: This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35–1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15–1.24 for SCC; HR = 2.32, 95% CI = 2.12–2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97–1.06) or AC (AHR = 1.09, 95% CI = 0.96–1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively). Conclusions: Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors.
KW - Adenocarcinoma
KW - Cervical cancer
KW - NCDB
KW - Propensity score analysis
KW - Racial disparities
KW - Squamous cell carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85184913792&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2024.02.005
DO - 10.1016/j.ygyno.2024.02.005
M3 - Article
C2 - 38340648
AN - SCOPUS:85184913792
SN - 0090-8258
VL - 184
SP - 224
EP - 235
JO - Gynecologic Oncology
JF - Gynecologic Oncology
ER -