Survival Disparities in Non-Hispanic Black and White Cervical Cancer Patients Vary by Histology and Are Largely Explained by Modifiable Factors

Authors

Calen W Kucera
Nicole P Chappell
Chunqiao Tian
Michael T Richardson
Christopher M Tarney
Chad A Hamilton
John K Chan
Daniel S Kapp
Charles A Leath
Yovanni Casablanca
Christine Rojas
Collin A Sitler
Lari Wenzel
Ann Klopp
Nathaniel L Jones
Rodney P Rocconi
John H Farley
Timothy D O'Connor
Craig D Shriver
Nicholas W Bateman
Thomas P Conrads
Neil T Phippen
G Larry Maxwell
Kathleen M Darcy

Publication Date

5-1-2024

Journal

Gynecologic Oncology

Abstract

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.

Keywords

Adult, Aged, Female, Humans, Middle Aged, Adenocarcinoma, Black or African American, Carcinoma, Squamous Cell, Health Status Disparities, Healthcare Disparities, Neoplasm Staging, Proportional Hazards Models, Socioeconomic Factors, United States, Uterine Cervical Neoplasms, White People, Cervical cancer, Racial disparities, Propensity score analysis, Adenocarcinoma, Squamous cell carcinoma, NCDB

DOI

10.1016/j.ygyno.2024.02.005

PMID

38340648

PMCID

PMC11361276

PubMedCentral® Posted Date

8-29-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes