Examining the effect of minority status and neighborhood characteristics on cervical cancer survival outcomes

• Published in: Gynecologic oncology 2011-04, Vol.121 (1), p.87-93
• Main Authors: Lim, Jung-won, Ashing-Giwa, Kimlin T
• Format: Article
• Language: English
• Subjects: Adult; Aged; California - epidemiology; Cervical cancer; Ethnic disparities; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Minority Groups; Multilevel survival analysis; Neighborhood variation; Neoplasm Staging; Obstetrics and Gynecology; Residence Characteristics; Socioeconomic Factors; Survival outcome; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - ethnology; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2010.11.041

Abstract Objective Understanding the factors that contribute to mortality and survival is central to health outcome research. The purpose of this study was to investigate the following: (1) differences in survival status by ethnicity and neighborhood median income level; and (2) individual- and neighborhood-level factors influencing cervical cancer survival. Methods This study was based on data from 1811 cervical cancer cases obtained through the California Cancer Surveillance Program. The dependent variable was days of survival from date of cancer diagnosis. Zip code-based neighborhood-level variables were obtained from Census 2000 data. Results Ethnicity was significantly associated with survival ( χ2 = 20.58; p < 0.001), with African–Americans showing the shortest survival. The 5-year survival rates of European–, African–, Latino–, and Asian–American patients for all stages combined were 85%, 75%, 85%, and 84%, respectively. Differences in survival between high- and low-income regions were not observed. However, when ethnicity was considered, Asian–Americans who lived in high-income regions showed longer survival than their low-income community counterparts ( χ2 = 4.531; p < 0.05). The multilevel model demonstrated ethnicity, age at diagnosis, and cancer stage stratified by surgery to be significantly associated with cervical cancer survival at the individual level. At the neighborhood level, residing in neighborhoods with a high proportion of African–Americans increased the risk of death by 1%. Conclusions The neighborhood context may be an influential contributor to survival for Asian– and African–Americans specifically. These findings necessitate closer examination of the unique contribution of ethnicity and neighborhood on cancer survival to disentangle the role of ethnic group membership, socio-ecological contexts and stress, and medical factors on disease outcomes.