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Goel N, Hernandez A, Cole SW. Social Genomic Determinants of Health: Understanding the Molecular Pathways by Which Neighborhood Disadvantage Affects Cancer Outcomes. J Clin Oncol 2024; 42:3618-3627. [PMID: 39178356 DOI: 10.1200/jco.23.02780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 08/25/2024] Open
Abstract
PURPOSE Neighborhoods represent complex environments with unique social, cultural, physical, and economic attributes that have major impacts on disparities in health, disease, and survival. Neighborhood disadvantage is associated with shorter breast cancer recurrence-free survival (RFS) independent of individual-level (race, ethnicity, socioeconomic status, insurance, tumor characteristics) and health system-level determinants of health (receipt of guideline-concordant treatment). This persistent disparity in RFS suggests unaccounted mechanisms such as more aggressive tumor biology among women living in disadvantaged neighborhoods compared with advantaged neighborhoods. The objective of this article was to provide a clear framework and biological mechanistic explanation for how neighborhood disadvantage affects cancer survival. METHODS Development of a translational epidemiological framework that takes a translational disparities approach to study cancer outcome disparities through the lens of social genomics and social epigenomics. RESULTS The social genomic determinants of health, defined as the physiological gene regulatory pathways (ie, neural/endocrine control of gene expression and epigenetic processes) through which contextual factors, particularly one's neighborhood, can affect activity of the cancer genome and the surrounding tumor microenvironment to alter disease progression and treatment outcomes. CONCLUSION We propose a novel, multilevel determinants of health model that takes a translational epidemiological approach to evaluate the interplay between political, health system, social, psychosocial, individual, and social genomic determinants of health to understand social disparities in oncologic outcomes. In doing so, we provide a concrete biological pathway through which the effects of social processes and social epidemiology come to affect the basic biology of cancer and ultimately clinical outcomes and survival.
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Affiliation(s)
- Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Alexandra Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Steven W Cole
- Department of Psychiatry/ Biobehavioral Sciences and Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
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LaRaja A, Connor Y, Poulson MR. The effect of urban racial residential segregation on ovarian cancer diagnosis, treatment, and survival. Gynecol Oncol 2024; 187:163-169. [PMID: 38788513 DOI: 10.1016/j.ygyno.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To investigate the effect of racial residential segregation on disparities between Black and White patients in stage at diagnosis, receipt of surgery, and survival. METHODS Subjects included Black and White patients diagnosed with ovarian cancer between 2005 and 2015 obtained from the Surveillance, Epidemiology, and End Results Program. Demographic data were obtained from the 2010 decennial census and 2013 American Community Survey. The exposure of interest was the index of dissimilarity (IOD), a validated measure of segregation. The outcomes of interest included relative risk of advanced stage at diagnosis and surgery for localized disease, 5-year overall and cancer-specific survival. RESULTS Black women were more likely to present with Stage IV ovarian cancer when compared to White (32% vs 25%, p < 0.001) and less often underwent surgical resection overall (64% vs 75%, p < 0.001). Increasing IOD was associated with a 25% increased risk of presenting at advanced stage for Black patients (RR 1.25, 95% CI 1.08, 1.45), and a 15% decrease for White patients (RR 0.85, 95% CI 0.73, 0.99). Increasing IOD was associated with an 18% decreased likelihood of undergoing surgical resection for black patients (RR 0.82, 95% CI 0.77, 0.87), but had no significant association for White patients (RR 1.01, 95% CI 0.96, 1.08). When compared to White patients in the lowest level of segregation, Black patients in the highest level of segregation had a 17% higher subhazard of death (HR 1.17, 95% CI 1.07, 1.27), while Black patients in the lowest level of segregation had no significant difference (HR 1.13, 95% CI 0.99, 1.29). CONCLUSION Our findings demonstrate the direct harm of historical government mandated segregation on Black women with ovarian cancer.
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Affiliation(s)
- Alexander LaRaja
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
| | - Yamicia Connor
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
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Lawson AB, Kim J, Johnson C, Ratnapradipa KL, Alberg AJ, Akonde M, Hastert T, Bandera EV, Terry P, Mandle H, Cote ML, Bondy M, Marks J, Peres LC, Schildkraut J, Peters ES. The Association between Mediated Deprivation and Ovarian Cancer Survival among African American Women. Cancers (Basel) 2023; 15:4848. [PMID: 37835542 PMCID: PMC10571563 DOI: 10.3390/cancers15194848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. METHODS We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. RESULTS The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen.
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Affiliation(s)
- Andrew B. Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Joanne Kim
- Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, OH 43210, USA;
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Kendra L. Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08625, USA
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, Knoxville, TN 37920, USA
| | - Hannah Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Michele L. Cote
- Bren Simon Comprehensive Cancer Center, Indiana University Melvin, Inidianapolis, IN 46202, USA;
| | - Melissa Bondy
- Department of Epidemiology and Population Health, College of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Jeffrey Marks
- Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Joellen Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (C.J.)
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Lawson AB, Kim J, Johnson C, Hastert T, Bandera EV, Alberg AJ, Terry P, Akonde M, Mandle H, Cote ML, Bondy M, Marks J, Peres L, Ratnapradipa KL, Xin Y, Schildkraut J, Peters ES. Deprivation and segregation in ovarian cancer survival among African American women: a mediation analysis. Ann Epidemiol 2023; 86:57-64. [PMID: 37423270 PMCID: PMC10538403 DOI: 10.1016/j.annepidem.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Deprivation and segregation indices are often examined as possible explanations for observed health disparities in population-based studies. In this study, we assessed the role of recognized deprivation and segregation indices specifically as they affect survival in a cohort of self-identified Black women diagnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study. METHODS Mediation analysis was used to examine the direct and indirect effects between deprivation or segregation and overall survival via a Bayesian structural equation model with Gibbs variable selection. RESULTS The results suggest that high socioeconomic status-related indices have an association with increased survival, ranging from 25% to 56%. In contrast, index of concentration at the extremes-race does not have a significant impact on overall survival. In many cases, the indirect effects have very wide credible intervals; consequently, the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS Our results show that Black women living in higher socioeconomic status neighborhoods are associated with increased survival with ovarian cancer using area-level economic indices such as Yost or index of concentration at the extremes-income. In addition, the Kolak urbanization index has a similar impact and highlights the importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.
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Affiliation(s)
- Andrew B Lawson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston; Usher Institute, Centre for Population Health Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
| | - Joanne Kim
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Paul Terry
- Department of Medicine, University of Tennessee Medical Center-Knoxville, Knoxville
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Hannah Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michele L Cote
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Melissa Bondy
- Department of Epidemiology and Population Health, Stanford University, College of Medicine, Stanford, CA
| | - Jeffrey Marks
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Lauren Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Yao Xin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Joellen Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Edward S Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
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Byrne CA, Gomez SL, Kim S, Oddo VM, Koh TJ, Fantuzzi G. Disparities in inflammation between non-Hispanic black and white individuals with lung cancer in the Greater Chicago Metropolitan area. Front Immunol 2022; 13:1008674. [PMID: 36544783 PMCID: PMC9760905 DOI: 10.3389/fimmu.2022.1008674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background Lung cancer incidence and mortality rates are higher in Non-Hispanic Black (NHB) compared to Non-Hispanic White (NHW) individuals in the Chicago metropolitan area, which may be related to exposure to chronic stress which may increase inflammation. Specific aim We investigated disparities in inflammation as measured by neutrophil to lymphocyte ratio (NLR) in individuals with lung cancer by race and by neighborhood concentrated disadvantage index (CDI). Methods This retrospective, cross-sectional study included 263 NHB and NHW adults with lung cancer. We analyzed NLR as a continuous and categorical variable to determine degree and prevalence of inflammation. We used Mann Whitney U, t-tests, Chi square tests, linear and logistic regression models as appropriate. Results More than 60% of subjects had inflammation (NLR ≥ 3) at lung cancer diagnosis. The degree of inflammation was significantly lower in NHB (NLR 5.50 +/- 7.45) compared to NHW individuals (NLR 6.53 +/- 6.53; p=0.01) but did not differ by neighborhood CDI. The prevalence of inflammation (NLR ≥ 3) was significantly lower in NHB (55.07%) compared to NHW individuals (71.20%; p<0.01) and in those from the most disadvantaged (54.07%) compared to the least disadvantaged (71.88%; p<0.01) neighborhoods. Conclusion At lung cancer diagnosis, there is a lower degree and prevalence of inflammation in NHB compared to NHW individuals, and lower prevalence in those residing in the most disadvantaged neighborhoods. Further research is needed to determine mechanisms of inflammation that may be contributing to lung cancer disparities as well as whether NLR is an appropriate biomarker when examining racial differences in inflammation.
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Affiliation(s)
- Cecily A. Byrne
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Sandra L. Gomez
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, United States
| | - Sage Kim
- School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Vanessa M. Oddo
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Timothy J. Koh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States,*Correspondence: Giamila Fantuzzi,
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Ochs-Balcom HM, Johnson C, Guertin KA, Qin B, Beeghly-Fadiel A, Camacho F, Bethea TN, Dempsey LF, Rosenow W, Joslin CE, Myers E, Moorman PG, Harris HR, Peres LC, Wendy Setiawan V, Wu AH, Rosenberg L, Schildkraut JM, Bandera EV. Racial differences in the association of body mass index and ovarian cancer risk in the OCWAA Consortium. Br J Cancer 2022; 127:1983-1990. [PMID: 36138071 PMCID: PMC9681872 DOI: 10.1038/s41416-022-01981-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Obesity disproportionately affects African American (AA) women and has been shown to increase ovarian cancer risk, with some suggestions that the association may differ by race. METHODS We evaluated body mass index (BMI) and invasive epithelial ovarian cancer (EOC) risk in a pooled study of case-control and nested case-control studies including AA and White women. We evaluated both young adult and recent BMI (within the last 5 years). Associations were estimated using multi-level and multinomial logistic regression models. RESULTS The sample included 1078 AA cases, 2582 AA controls, 3240 White cases and 9851 White controls. We observed a higher risk for the non-high-grade serous (NHGS) histotypes for AA women with obesity (ORBMI 30+= 1.62, 95% CI: 1.16, 2.26) and White women with obesity (ORBMI 30+= 1.20, 95% CI: 1.02, 2.42) compared to non-obese. Obesity was associated with higher NHGS risk in White women who never used HT (ORBMI 30+= 1.40, 95% CI: 1.08, 1.82). Higher NHGS ovarian cancer risk was observed for AA women who ever used HT (ORBMI 30+= 2.66, 95% CI: 1.15, 6.13), while in White women, there was an inverse association between recent BMI and risk of EOC and HGS in ever-HT users (EOC ORBMI 30+= 0.81, 95% CI: 0.69, 0.95, HGS ORBMI 30+= 0.73, 95% CI: 0.61, 0.88). CONCLUSION Obesity contributes to NHGS EOC risk in AA and White women, but risk across racial groups studied differs by HT use and histotype.
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Affiliation(s)
- Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin A Guertin
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington DC, USA
| | - Lauren F Dempsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Will Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, IL, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Patricia G Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - V Wendy Setiawan
- University of Southern California Norris Comprehensive Cancer Center, and Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anna H Wu
- University of Southern California Norris Comprehensive Cancer Center, and Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Nash R, Johnson CE, Harris HR, Peres LC, Joslin CE, Bethea TN, Bandera EV, Ochs-Balcom HM, Myers ER, Guertin KA, Camacho F, Beeghly-Fadiel A, Moorman PG, Setiawan VW, Rosenberg L, Schildkraut JM, Wu AH. Race Differences in the Associations between Menstrual Cycle Characteristics and Epithelial Ovarian Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1610-1620. [PMID: 35654411 PMCID: PMC9711941 DOI: 10.1158/1055-9965.epi-22-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Menstrual cycle characteristics-including age at menarche and cycle length- have been associated with ovarian cancer risk in White women. However, the associations between menstrual cycle characteristics and ovarian cancer risk among Black women have been sparsely studied. METHODS Using the Ovarian Cancer in Women of African Ancestry (OCWAA) Consortium that includes 1,024 Black and 2,910 White women diagnosed with epithelial ovarian cancer (EOC) and 2,325 Black and 7,549 White matched controls, we investigated associations between menstrual cycle characteristics (age at menarche, age at menstrual regularity, cycle length, and ever missing three periods) and EOC risk by race and menopausal status. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Black women were more likely to be <11 years at menarche than White women (controls: 9.9% vs. 6.0%). Compared with ≥15 years at menarche, <11 years was associated with increased EOC risk for White (OR = 1.25; 95% CI, 0.99-1.57) but not Black women (OR = 1.10; 95% CI, 0.80-1.55). Among White women only, the association was greater for premenopausal (OR = 2.20; 95% CI, 1.31-3.68) than postmenopausal women (OR = 1.06; 95% CI, 0.82-1.38). Irregular cycle length was inversely associated with risk for White (OR = 0.78; 95% CI, 0.62-0.99) but not Black women (OR = 1.06; 95% CI, 0.68-1.66). CONCLUSIONS Earlier age at menarche and cycle irregularity are associated with increased EOC risk for White but not Black women. IMPACT Associations between menstrual cycle characteristics and EOC risk were not uniform by race.
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Affiliation(s)
- Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
| | - Courtney E Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
| | - Holly R. Harris
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, IL
| | - Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, DC
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Evan R. Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Kristin A Guertin
- Department of Population Health and Prevention Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Fabian Camacho
- Department of Population Health and Prevention Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Alicia Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Patricia G. Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC
| | - Veronica Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
| | - Anna H. Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Wagle NS, Park S, Washburn D, Ohsfeldt RL, Rich NE, Singal AG, Kum H. Racial, Ethnic, and Socioeconomic Disparities in Curative Treatment Receipt and Survival in Hepatocellular Carcinoma. Hepatol Commun 2022; 6:1186-1197. [PMID: 34796703 PMCID: PMC9035560 DOI: 10.1002/hep4.1863] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022] Open
Abstract
Hepatocellular carcinoma (HCC) disproportionately affects racial, ethnic, and low socioeconomic status (SES) populations. However, the interaction between race, ethnicity, and neighborhood SES in HCC prognosis is not well explored. This study evaluates the interaction between race and ethnicity and neighborhood SES on curative treatment utilization and overall survival among patients with HCC in the United States. We conducted a retrospective cohort study of 13,874 patients aged ≥65 years diagnosed with HCC from 2001 through 2015 using the Surveillance, Epidemiology, and End Results Medicare-linked database. We performed multivariable logistic regression to examine the association between race, ethnicity, and curative treatment receipt across SES. We also evaluated the association between curative treatment receipt and overall survival using a Cox proportional hazards model. Among 13,874 patients, only 2,617 (18.9%) patients received curative treatment. Overall, Black patients had lower odds of receiving curative treatment than White patients (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.64-0.91). When stratified by neighborhood SES, Black patients living in high-poverty neighborhoods had lower odds of curative treatment receipt (OR, 0.64; 95% CI, 0.49-0.84) and worse survival (hazard ratio, 1.13; 95% CI, 1.02-1.25). Conversely, Hispanic and Asian patients had similar curative treatment receipt compared to White patients across all socioeconomic levels. Conclusion: Disparities in curative treatment receipt and overall survival are pronounced between Black and White patients. Black-White disparities appear to be moderated by neighborhood SES and are particularly evident among those living in high-poverty neighborhoods.
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Affiliation(s)
- Nikita Sandeep Wagle
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
| | - Sulki Park
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Industrial and Systems EngineeringTexas A&M UniversityCollege StationTXUSA
| | - David Washburn
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
| | - Robert L. Ohsfeldt
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
| | - Nicole E. Rich
- Division of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Amit G. Singal
- Division of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Hye‐Chung Kum
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
- Department of Industrial and Systems EngineeringTexas A&M UniversityCollege StationTXUSA
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Bethea TN, Ochs-Balcom HM, Bandera EV, Beeghly-Fadiel A, Camancho F, Chyn D, Cloyd EK, Harris HR, Joslin CE, Myers E, Moorman PG, Peres LC, Rosenow W, Setiawan VW, Wu AH, Rosenberg L, Schildkraut JM. First- and second-degree family history of ovarian and breast cancer in relation to risk of invasive ovarian cancer in African American and white women. Int J Cancer 2021; 148:2964-2973. [PMID: 33521947 PMCID: PMC8353974 DOI: 10.1002/ijc.33493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
Family history (FH) of ovarian cancer and breast cancer are well-established risk factors for ovarian cancer, but few studies have examined this association in African American (AA) and white women by histotype. We assessed first- and second-degree FH of ovarian and breast cancer and risk of epithelial ovarian cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Analyses included 1052 AA cases, 2328 AA controls, 2380 white cases and 3982 white controls. Race-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multilevel logistic regression with adjustment for covariates. Analyses were stratified by histotype (high-grade serous vs others). First-degree FH of ovarian cancer was associated with high-grade serous carcinoma in AA (OR = 2.32, 95% CI: 1.50, 3.59) and white women (OR = 2.48, 95% CI: 1.82, 3.38). First-degree FH of breast cancer increased risk irrespective of histotype in AAs, but with high-grade serous carcinoma only in white women. Associations with second-degree FH of ovarian cancer were observed for overall ovarian cancer in white women and with high-grade serous carcinoma in both groups. First-degree FH of ovarian cancer and of breast cancer, and second-degree FH of ovarian cancer is strongly associated with high-grade serous ovarian carcinoma in AA and white women. The association of FH of breast cancer with high-grade serous ovarian carcinoma is similar in white women and AA women, but may differ for other histotypes.
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Affiliation(s)
- Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, D.C., USA
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabian Camancho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Deanna Chyn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Emily K. Cloyd
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Charlotte E. Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Patricia G. Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Will Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Veronica W. Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Anna H. Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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10
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Adherence to treatment guidelines as a major determinant of survival disparities between black and white patients with ovarian cancer. Gynecol Oncol 2020; 160:10-15. [PMID: 33208254 DOI: 10.1016/j.ygyno.2020.10.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/31/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether non-adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines and other factors related to treatment access contribute to racial disparities in ovarian cancer survival. METHODS This large cohort study included patients from the National Cancer Database who were diagnosed with ovarian cancer between 2004 and 2014, with follow-up data up to 2017. The multivariable Cox regression was used to assess the effect of study variables on five-year overall survival. The proportion contributions of prognostic factors to the survival disparities were estimated using individual and sequential adjustment of these factors based on the Cox proportional hazards models. RESULTS Of the 120,712 patients eligible for this study, 110,032 (91.1%) were whites and 10,680 (8.9%) were blacks. Black patients, compared with their white counterparts, had a lower adherence to NCCN guidelines (60.8% vs. 70.4%, respectively, P < 0.001), and a higher five-year mortality after cancer diagnosis (age- and tumor characteristics- adjusted hazard ratio: 1.22, 95% confidence interval: 1.19-1.25). Non-adherence to NCCN treatment guidelines was the most significant contributor to racial disparity in ovarian cancer survival, followed by access to care and comorbidity, each explaining 36.4%, 22.7%, and 18.2% of the racial differences in five-year overall survival, respectively. These factors combined explain 59.1% of racial survival disparities. Risk factors identified for non-adherence to treatment guidelines among blacks include insurance status, treatment facility type, educational attainment, age, and comorbidity. CONCLUSIONS Adherence status to NCCN treatment guidelines is the most important contributor to the survival disparities between black and white patients with ovarian cancer. Our findings call for measures to promote equitable access to guideline-adherence care to improve the survival of black women with ovarian cancer.
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11
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Mosgaard BJ, Meaidi A, Høgdall C, Noer MC. Risk factors for early death among ovarian cancer patients: a nationwide cohort study. J Gynecol Oncol 2020; 31:e30. [PMID: 32026656 PMCID: PMC7189078 DOI: 10.3802/jgo.2020.31.e30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/26/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To characterize ovarian cancer patients who die within 6 months of diagnosis and to identify prognostic factors for these early deaths. Methods A nationwide cohort study covering ovarian cancer in Denmark in 2005–2016. Tumor and patient characteristics including comorbidity and socioeconomic factors were obtained from the comprehensive Danish national registers. Results A total of 5,570 patients were included in the study. Three months after ovarian cancer diagnosis 456 (8.2%) had died and 664 (11.9%) died within 6 months of diagnosis. Adjusted for age and comorbidity, patients who died early were admitted to hospital significantly more often in a 6-month period before the diagnosis (odds ratio [OR]=1.61 [1.29–2.00], and OR=1.47 [1.21–1.78]), for patients who died within 3 and 6 months respectively). Low educational level (OR=2.11), low income (OR=2.50) and singlehood (OR=1.90) were factors significantly associated with higher risk of early death. The discriminative ability of risk factors in identifying early death was assessed by cross-validated area under the receiver operating characteristic curve (AUC). The AUC was found to be 0.91 (0.88–0.93) and 0.90 (0.87–0.92) for death within 3 and 6 months, respectively. Conclusions Despite several admissions to hospital, the ovarian cancer diagnosis is delayed for a subgroup of patients, who end up dying early, probably due to physical deterioration in the ineffective waiting time. Up to 90% of high-risk patients might be identified significantly earlier to improve the prognosis. The admittance of the patients having risk symptoms should include fast track investigation for ovarian cancer.
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Affiliation(s)
- Berit Jul Mosgaard
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Amani Meaidi
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Høgdall
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mette Calundann Noer
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Karanth S, Fowler ME, Mao X, Wilson LE, Huang B, Pisu M, Potosky A, Tucker T, Akinyemiju T. Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer Treatment and Mortality: Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2019; 3:pkz084. [PMID: 31840133 PMCID: PMC6899434 DOI: 10.1093/jncics/pkz084] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/23/2019] [Accepted: 10/04/2019] [Indexed: 01/11/2023] Open
Abstract
Background Ovarian cancer remains a leading cause of death from gynecological malignancies. Race, socioeconomic status (SES), and access to health care are important predictors of quality treatment and survival. We provide a systematic review and meta-analysis on the role of these predictors on disparities in ovarian cancer treatment and mortality. Methods Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, EMBASE, and Scopus for relevant articles published between January 2000 and March 2017. We selected studies published in the United States that evaluated the role of race, SES, or health-care access on disparities in ovarian cancer treatment or survival. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated for each outcome using a random-effects model. Results A total of 41 studies met the inclusion criteria for systematic review. In meta-analysis, there was a 25% decrease (RR = 0.75, 95% CI = 0.66 to 0.84) in receipt of adherent ovarian cancer treatment and 18% increased risk (RR = 1.18, 95% CI = 1.11 to 1.26) of mortality for blacks compared to whites. Receipt of adherent ovarian cancer treatment was 15% lower (RR = 0.85, 95% CI = 0.77 to 0.94) in the lowest vs highest SES group and 30% lower (RR = 0.70, 95% CI = 0.58 to 0.85) among patients at lower vs higher hospital volumes. Conclusion We found consistent and strong evidence for continued lack of quality ovarian cancer treatment and higher mortality among ovarian cancer patients who are black, are of low SES, and/or have poor access to care. Interventions focused on these groups targeting specific barriers to care are needed to reduce disparities in ovarian cancer treatment and mortality.
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Affiliation(s)
- Shama Karanth
- See the Notes section for the full list of authors' affiliations
| | | | - XiHua Mao
- See the Notes section for the full list of authors' affiliations
| | - Lauren E Wilson
- See the Notes section for the full list of authors' affiliations
| | - Bin Huang
- See the Notes section for the full list of authors' affiliations
| | - Maria Pisu
- See the Notes section for the full list of authors' affiliations
| | - Arnold Potosky
- See the Notes section for the full list of authors' affiliations
| | - Tom Tucker
- See the Notes section for the full list of authors' affiliations
| | - Tomi Akinyemiju
- See the Notes section for the full list of authors' affiliations
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13
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Schildkraut JM, Peres LC, Bethea TN, Camacho F, Chyn D, Cloyd EK, Bandera EV, Beeghly-Fadiel A, Lipworth L, Joslin CE, Davis FG, Moorman PG, Myers E, Ochs-Balcom HM, Setiawan VW, Pike MC, Wu AH, Rosenberg L. Ovarian Cancer in Women of African Ancestry (OCWAA) consortium: a resource of harmonized data from eight epidemiologic studies of African American and white women. Cancer Causes Control 2019; 30:967-978. [PMID: 31236792 PMCID: PMC7325484 DOI: 10.1007/s10552-019-01199-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/17/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Although the incidence rate of epithelial ovarian cancer (EOC) is somewhat lower in African American (AA) than white women, survival is worse. The Ovarian Cancer in Women of African Ancestry (OCWAA) consortium will overcome small, study-specific sample sizes to better understand racial differences in EOC risk and outcomes. METHODS We harmonized risk factors and prognostic characteristics from eight U.S. STUDIES the North Carolina Ovarian Cancer Study (NCOCS), the Los Angeles County Ovarian Cancer Study (LACOCS), the African American Cancer Epidemiology Study (AACES), the Cook County Case-Control Study (CCCCS), the Black Women's Health Study (BWHS), the Women's Health Initiative (WHI), the Multiethnic Cohort Study (MEC), and the Southern Community Cohort Study (SCCS). RESULTS Determinants of disparities for risk and survival in 1,146 AA EOC cases and 2,922 AA controls will be compared to 3,368 white EOC cases and 10,270 white controls. Analyses include estimation of population-attributable risk percent (PAR%) by race. CONCLUSION OCWAA is uniquely positioned to study the epidemiology of EOC in AA women compared with white women to address disparities. Studies of EOC have been underpowered to address factors that may explain AA-white differences in the incidence and survival. OCWAA promises to provide novel insight into disparities in ovarian cancer.
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Affiliation(s)
- Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA, 22903, USA.
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Traci N Bethea
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA, 22903, USA
| | - Deanna Chyn
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA, 22903, USA
| | - Emily K Cloyd
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA, 22903, USA
| | - Elisa V Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Alicia Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago School of Medicine, Chicago, IL, USA
| | - Faith G Davis
- School of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Patricia G Moorman
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | | | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA, USA
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14
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Wen H, Botticello AL, Bae S, Heinemann AW, Boninger M, Houlihan BV, Chen Y. Racial and Ethnic Differences in Obesity in People With Spinal Cord Injury: The Effects of Disadvantaged Neighborhood. Arch Phys Med Rehabil 2019; 100:1599-1606. [PMID: 30922881 DOI: 10.1016/j.apmr.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/11/2019] [Accepted: 02/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI). DESIGN A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract. SETTING A total of 17 SCI Model Systems centers. PARTICIPANTS Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Body mass index (BMI) (kg/m2). RESULTS The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods. CONCLUSIONS Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.
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Affiliation(s)
- Huacong Wen
- Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL, the United States; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, the United States
| | - Amanda L Botticello
- Kessler Foundation, West Orange, NJ, the United States; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, the United States
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, the United States
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL, the United States; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, the United States
| | - Mike Boninger
- Departments of Physical Medicine and Rehabilitation, Bioengineering, and Rehabilitation Science and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, the United States
| | - Bethlyn Vergo Houlihan
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, the United States; Spaulding Rehabilitation Hospital, Boston, MA, the United States
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, the United States.
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15
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Hossain F, Danos D, Prakash O, Gilliland A, Ferguson TF, Simonsen N, Leonardi C, Yu Q, Wu XC, Miele L, Scribner R. Neighborhood Social Determinants of Triple Negative Breast Cancer. Front Public Health 2019; 7:18. [PMID: 30834239 PMCID: PMC6387917 DOI: 10.3389/fpubh.2019.00018] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 01/07/2023] Open
Abstract
Triple Negative Breast Cancer (TNBC) is an aggressive, heterogeneous subtype of breast cancer, which is more frequently diagnosed in African American (AA) women than in European American (EA) women. The purpose of this study is to investigate the role of social determinants in racial disparities in TNBC. Data on Louisiana TNBC patients diagnosed in 2010–2012 were collected and geocoded to census tract of residence at diagnosis by the Louisiana Tumor Registry. Using multilevel statistical models, we analyzed the role of neighborhood concentrated disadvantage index (CDI), a robust measure of physical and social environment, in racial disparities in TNBC incidence, stage at diagnosis, and stage-specific survival for the study population. Controlling for age, we found that AA women had a 2.21 times the incidence of TNBC incidence compared to EA women. Interestingly, the incidence of TNBC was independent of neighborhood CDI and adjusting for neighborhood environment did not impact the observed racial disparity. AA women were more likely to be diagnosed at later stages and CDI was associated with more advanced stages of TNBC at diagnosis. CDI was also significantly associated with poorer stage-specific survival. Overall, our results suggest that neighborhood disadvantage contributes to racial disparities in stage at diagnosis and survival among TNBC patients, but not to disparities in incidence of the disease. Further research is needed to determine the mechanisms through which social determinants affect the promotion and progression of this disease and guide efforts to improve overall survival.
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Affiliation(s)
- Fokhrul Hossain
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Denise Danos
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Om Prakash
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Aubrey Gilliland
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Tekeda F Ferguson
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Neal Simonsen
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Claudia Leonardi
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Qingzhao Yu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Lucio Miele
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Richard Scribner
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
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16
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Gardy J, Dejardin O, Thobie A, Eid Y, Guizard AV, Launoy G. Impact of socioeconomic status on survival in patients with ovarian cancer. Int J Gynecol Cancer 2019; 29:792-801. [PMID: 30712018 DOI: 10.1136/ijgc-2018-000097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Socioeconomic status may impact survival in cancer patients. This study assessed whether low socioeconomic status has an impact on survival in patients with ovarian cancer and investigated whether differences in survival may be explained by type of therapy received. METHODS The study population comprised 318 patients with ovarian cancer diagnosed between 2011 and 2015 in the François Baclesse regional cancer care center in Caen, North-West France. Socioeconomic status was assessed by using the European deprivation index and overall survival was calculated at 3 years. RESULTS The unadjusted 3-year overall survival rate was 52% (95% CI 47 to 58). In a multivariable logistic regression model, a low socioeconomic status was associated with a lower probability of surgical resection (OR 0.34, 95% CI 0.16 to 0.74). A high socioeconomic status was associated with improved survival, adjusted for age, performance status, grade, and International Federation of Gynecology and Obstetrics (FIGO) stage (adjusted HR 1.53, 95% CI 1.04 to 2.26). When adjusting for treatment variables, there was no longer any significant difference in survival according to socioeconomic status (adjusted HR 1.24, 95% CI 0.83 to 1.84). CONCLUSIONS Higher socioeconomic status is associated with a greater probability of undergoing surgical resection and with improved survival in patients with ovarian cancer.
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Affiliation(s)
- Joséphine Gardy
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France .,Calvados General Cancer Registry, Caen, France.,Calvados Digestive Cancer Registry, Caen, France
| | - Olivier Dejardin
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.,University Hospital of Caen, Caen, France
| | - Alexandre Thobie
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Yassine Eid
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Anne-Valérie Guizard
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.,Calvados General Cancer Registry, Caen, France
| | - Guy Launoy
- "ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.,Calvados Digestive Cancer Registry, Caen, France.,University Hospital of Caen, Caen, France
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17
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Danos DM, Ferguson TF, Simonsen NR, Leonardi C, Yu Q, Wu XC, Scribner RA. Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana. Ann Epidemiol 2018; 28:316-321.e2. [PMID: 29678311 DOI: 10.1016/j.annepidem.2018.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/09/2018] [Accepted: 02/09/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Colorectal cancer (CRC) continues to demonstrate racial disparities in incidence and survival in the United States. This study investigates the role of neighborhood concentrated disadvantage in racial disparities in CRC incidence in Louisiana. METHODS Louisiana Tumor Registry and U.S. Census data were used to assess the incidence of CRC diagnosed in individuals 35 years and older between 2008 and 2012. Neighborhood concentrated disadvantage index (CDI) was calculated based on the PhenX Toolkit protocol. The incidence of CRC was modeled using multilevel binomial regression with individuals nested within neighborhoods. RESULTS Our study included 10,198 cases of CRC. Adjusting for age and sex, CRC risk was 28% higher for blacks than whites (risk ratio [RR] = 1.28; 95% confidence interval [CI] = 1.22-1.33). One SD increase in CDI was associated with 14% increase in risk for whites (RR = 1.14; 95% CI = 1.10-1.18) and 5% increase for blacks (RR = 1.05; 95% CI = 1.02-1.09). After controlling for differential effects of CDI by race, racial disparities were not observed in disadvantaged areas. CONCLUSION CRC incidence increased with neighborhood disadvantage and racial disparities diminished with mounting disadvantage. Our results suggest additional dimensions to racial disparities in CRC outside of neighborhood disadvantage that warrants further research.
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Affiliation(s)
- Denise M Danos
- Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA
| | - Tekeda F Ferguson
- Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA.
| | - Neal R Simonsen
- Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA
| | - Claudia Leonardi
- Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Community and Behavioral Health, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA
| | - Qingzhao Yu
- Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Biostatistics, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA; Louisiana Tumor Registry, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA
| | - Richard A Scribner
- Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA
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18
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Hashim D, Manczuk M, Holcombe R, Lucchini R, Boffetta P. Cancer mortality disparities among New York City's Upper Manhattan neighborhoods. Eur J Cancer Prev 2017; 26:453-460. [PMID: 27104595 PMCID: PMC5074912 DOI: 10.1097/cej.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.
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Affiliation(s)
- Dana Hashim
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marta Manczuk
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cancer Epidemiology, Maria Skłodowska-Curie Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Randall Holcombe
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Lucchini
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Occupational Medicine, University of Brescia, Italy
| | - Paolo Boffetta
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Srivastava SK, Ahmad A, Miree O, Patel GK, Singh S, Rocconi RP, Singh AP. Racial health disparities in ovarian cancer: not just black and white. J Ovarian Res 2017; 10:58. [PMID: 28931403 PMCID: PMC5607508 DOI: 10.1186/s13048-017-0355-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/01/2017] [Indexed: 01/24/2023] Open
Abstract
Ovarian cancer (OC) is the most lethal gynecological malignancy, which disproportionately affects African American (AA) women. Lack of awareness and socioeconomic factors are considered important players in OC racial health disparity, while at the same time, some recent studies have brought focus on the genetic basis of disparity as well. Differential polymorphisms, mutations and expressions of genes have been reported in OC patients of diverse racial and ethnic backgrounds. Combined, it appears that neither genetic nor the socioeconomic factors alone might explain the observed racially disparate health outcomes among OC patients. Rather, a more logical explanation would be the one that takes into consideration the combination and/or the interplay of these factors, perhaps even including some environmental ones. Hence, in this article, we attempt to review the available information on OC racial health disparity, and provide an overview of socioeconomic, environmental and genetic factors, as well as the epigenetic changes that can act as a liaison between the three. A better understanding of these underlying causes will help further research on effective cancer management among diverse patient population and ultimately narrow health disparity gaps.
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Affiliation(s)
- Sanjeev K Srivastava
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA. .,Division of Cell Biology and Genetics, Tatva Biosciences, Coastal Innovation Hub, 600 Clinic Drive, Mobile, AL, 36688, USA.
| | - Aamir Ahmad
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA
| | - Orlandric Miree
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA
| | - Girijesh Kumar Patel
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA
| | - Seema Singh
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA.,Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, AL, 36688, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, 36604, USA
| | - Ajay P Singh
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA. .,Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, AL, 36688, USA.
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20
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Vieira VM, Villanueva C, Chang J, Ziogas A, Bristow RE. Impact of community disadvantage and air pollution burden on geographic disparities of ovarian cancer survival in California. ENVIRONMENTAL RESEARCH 2017; 156:388-393. [PMID: 28395243 PMCID: PMC5467739 DOI: 10.1016/j.envres.2017.03.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 05/07/2023]
Abstract
Ovarian cancer survival varies geographically throughout California. The objective of this study is to determine the impact of living in disadvantaged communities on spatial patterns of survival disparities. Including a bivariate spatial smooth of geographic location within the Cox proportional hazard models is an effective approach for spatial analyses of cancer survival. Women diagnosed with advanced Stage IIIC/IV epithelial ovarian cancer (1996-2006) were identified from the California Cancer Registry. The impact of living in disadvantaged communities, as measured by the California Office of Environmental Health Hazard Assessment cumulative CalEnviroScreen 2.0 score, on geographic disparities in survival was assessed while controlling for age, tumor characteristics, quality of care, and race. Community-level air quality indicators and socioeconomic status (SES) were also independently examined in secondary analyses. The Cox proportional hazard spatial methods are available in the MapGAM package implemented in R. An increase in the community disadvantage from the 5th (less disadvantage) to the 95th percentile (more disadvantage) was significantly associated with poorer ovarian cancer survival (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.07-1.26). Ozone levels and SES were the most influential indicators on geographic disparities that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential air quality-related predictors of geographic disparities.
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Affiliation(s)
- Verónica M Vieira
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, United States; Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, United States.
| | - Carolina Villanueva
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA, United States
| | - Jenny Chang
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, United States
| | - Argyrios Ziogas
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA, United States
| | - Robert E Bristow
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, United States; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, United States
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21
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Ross J, Braswell KV, Madeira da Silva L, Mujica F, Stutsman S, Finan MA, Nicolson W, Harmon MD, Missanelli M, Cohen A, Singh A, Scalici JM, Rocconi RP. Unraveling the etiology of ovarian cancer racial disparity in the deep south: Is it nature or nurture? Gynecol Oncol 2017; 145:329-333. [PMID: 28215839 DOI: 10.1016/j.ygyno.2017.02.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Our objective was to evaluate racial treatment and survival disparities in black women with ovarian cancer in the Deep South and to determine how environmental factors / socioeconomic status (SES) influence survival. METHODS A retrospective study of ovarian cancer patients from 2007 to 2014 was performed. Socioeconomic status (SES) was obtained though U.S. Census block data and compared using Yost scores. Comparisons were performed using standard statistical approaches. RESULTS A total of 393 patients were evaluated, 325 (83%) white and 68 (17%) black. Demographic information and surgical approach were similar in each racial group. However, compared to whites, black patients had lower rates of optimal debulking [89% vs. 71%, respectively (p=0.001)] and intraperitoneal chemotherapy (19% vs. 11%, p=0.01). Black women had lower SES parameters including education, income, and poverty. As a result, more black patients had the lowest SES (SES-1) when compared to white patients (17% vs. 41%, p<0.001). When controlling for these factors by cox regression analysis, a survival disadvantage was seen in black women for both progression free survival (16 vs. 27months, p=0.003) and overall survival (42 vs. 88months, p<0.001). CONCLUSIONS Despite controlling for clinical and environmental factors, a survival disadvantage was still observed in black patients with ovarian cancer in the Deep South. Black women had lower optimal debulking rates and more platinum resistant disease. These data suggest other factors like tumor biology may play a role in racial survival differences, however, more research is needed to determine this causation.
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Affiliation(s)
- Jerlinda Ross
- University of Chicago, Gynecologic Oncology Division, Chicago, IL, USA
| | | | | | - Frances Mujica
- University of South Alabama, Department of Earth Sciences, Mobile, AL, USA
| | - Sam Stutsman
- University of South Alabama, Department of Earth Sciences, Mobile, AL, USA
| | - Michael A Finan
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - William Nicolson
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | | | - Megan Missanelli
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Alex Cohen
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Ajay Singh
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | | | - Rodney P Rocconi
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA.
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22
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Poole EM, Konstantinopoulos PA, Terry KL. Prognostic implications of reproductive and lifestyle factors in ovarian cancer. Gynecol Oncol 2016; 142:574-87. [DOI: 10.1016/j.ygyno.2016.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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23
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Brewer KC, Peterson CE, Davis FG, Hoskins K, Pauls H, Joslin CE. The influence of neighborhood socioeconomic status and race on survival from ovarian cancer: a population-based analysis of Cook County, Illinois. Ann Epidemiol 2015; 25:556-63. [PMID: 25986734 DOI: 10.1016/j.annepidem.2015.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Despite significant improvements in treatment for ovarian cancer, survival is poorer for non-Hispanic black (NHB) women compared to non-Hispanic white (NHW) women. Neighborhood socioeconomic status (SES) has been implicated in racial disparities across a variety of health outcomes and may similarly contribute to racial disparities in ovarian cancer survival. The purpose of this analysis is to assess the influence of neighborhood SES on NHB-NHW survival differences after accounting for differences in tumor characteristics and in treatment. METHODS Data were obtained from 2432 women (443 NHB and 1989 NHW) diagnosed with epithelial ovarian cancer in Cook County, Illinois between 1998 and 2007. Neighborhood (i.e., census tract) SES at the time of diagnosis was calculated for each woman using two well-established composite measures of affluence and disadvantage. Cox proportional hazard models measured the association between NHB race and survival after adjusting for age, tumor characteristics, treatment, year of diagnosis, and neighborhood SES. RESULTS There was a strong association between ovarian cancer survival and both measures of neighborhood SES (P < .0001 for both affluence and disadvantage). After adjusting for age, tumor characteristics, treatment, and year of diagnosis, NHB were more likely than NHW to die of ovarian cancer (hazard ratio [HR] = 1.47, 95% confidence interval [CI]: 1.28-1.68). The inclusion of neighborhood affluence and disadvantage into models separately and together attenuated this risk (HRaffluence = 1.37, 95% CI: 1.18-1.58; HRdisadvantage = 1.28, 95% CI: 1.08-1.52; and HRaffluence + disadvantage = 1.28, 95% CI: 1.08-1.52. CONCLUSIONS Neighborhood SES, as measured by composite measures of affluence and disadvantage, is a predictor of survival in women diagnosed with ovarian cancer in Cook County, Illinois and may contribute to the racial disparity in survival.
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Affiliation(s)
- Katherine C Brewer
- Division of Epidemiology and Biostatistics (MC 923), School of Public Health, University of Illinois at Chicago, Chicago
| | - Caryn E Peterson
- Division of Epidemiology and Biostatistics (MC 923), School of Public Health, University of Illinois at Chicago, Chicago; Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago
| | - Faith G Davis
- Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago; Department of Public Health Sciences, School of Public Health, University of Alberta, 3-317 Edmonton Clinic Health Academy, Alberta, Canada
| | - Kent Hoskins
- Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago; Department of Hematology and Oncology, University of Illinois at Chicago, Chicago
| | - Heather Pauls
- Institute for Health Research and Policy (IHRP), University of Illinois at Chicago, Chicago
| | - Charlotte E Joslin
- Division of Epidemiology and Biostatistics (MC 923), School of Public Health, University of Illinois at Chicago, Chicago; Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago.
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