The impact of socioeconomic status on ovarian cancer survival among Georgia women diagnosed from 2001-2005 Pubblico

Abstract

Abstract

THE IMPACT OF SOCIOECONOMIC STATUS ON OVARIAN CANCER SURVIVAL AMONG GEORGIA WOMEN DIAGNOSED FROM 2001-2005

By Lisa Melissa Matz

Objectives: The goal of this study was to examine the impact of socioeconomic status (SES) on ovarian cancer survival among women in Georgia who were diagnosed with malignant ovarian cancer from 2001-2005 with follow-up until 2008. Low SES has been previously shown to negatively impact health outcomes, though the impact on ovarian cancer survival is relatively unknown. Knowing the impact of SES will help to more fully understand disparities in ovarian cancer survival.

Methods: Using data from the Georgia Cancer Registry, all cases of malignant ovarian cancer among women in Georgia were identified. Based on the recommendations of the Public Health Disparities Geocoding Project, percentage of persons living in poverty by census tract was used an area-based measure of SES. Three-year cause-specific survival adjusted for age, race, marital status, stage, histology, grade, and treatment was estimated using Cox proportional hazards modeling. Three-year relative survival ratios were estimated using age and year-specific U.S life tables. Cause-specific and relative survival were estimated for cases with a single primary ovarian cancer and subsequently for all cases regardless of other cancer diagnoses.

Results: Women living in areas with the highest poverty had significantly lower 3-year cause-specific survival than women living in areas with little to no poverty. After controlling for covariates, the hazard ratio for women living in the highest poverty category was 1.44 (95% CI: 1.18, 1.76). Including cases with prior or subsequent cancer diagnoses also resulted in a significant association (HR (95% CI) = 1.48 (1.23, 1.78)). Compared to women living in areas with little to no poverty, three-year relative survival was lowest for women living in the highest poverty category (38% vs. 64%). This relationship held when higher order cancers were included in the analysis (39% vs. 65%).

Conclusions: This study identified SES as a significant factor in ovarian cancer survival among women living in Georgia. Women living in poverty are at greater risk of dying from ovarian cancer compared to women living low poverty. Future research should focus on decomposing this relationship to determine precisely how low SES negatively impacts ovarian cancer survival.

Table of Contents

Table of Contents Introduction.............................................................................................................1 Methods..................................................................................................................8 Study Population...........................................................................................8 Socioeconomic Status....................................................................................8 Covariates....................................................................................................9 Statistical Analyses........................................................................................9 Results...................................................................................................................12 Discussion...............................................................................................................16 Strengths and Limitations..............................................................................19 Future Directions..........................................................................................20 References..............................................................................................................21 Tables....................................................................................................................29 Figures...................................................................................................................36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Parola chiave	ovarian cancer cause-specific survival inequalities disparities socioeconomic Georgia poverty relative survival survival
Committee Chair / Thesis Advisor	Ward, Kevin C., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Georgia state or local agency (not a health department)

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