Cervical cancer outcomes analysis: impact of age, race, and comorbid illness on hospitalizations for invasive carcinoma of the cervix.
OBJECTIVE
The aim of this study was to evaluate the association of age, race, and comorbid illness with procedures and complications in hospitalized patients with invasive carcinoma of the cervix in a statewide population-based database over a 3-year period.


METHODS
Hospitalizations were classified into homogeneous subgroups based on a diagnosis of invasive cervical cancer. Cancer-related complications and comorbid diseases were evaluated. chi(2) and t tests determined differences in means or proportions. Linear regression techniques were applied to build models for hospitalization charges and lengths of stay (LOS).


RESULTS
There were 1009 admissions. The mean age was 49.5, with a median age of 46 (21-100, SD 15.4). Of the total, 606/1009 (60%) were white, 354/1009 (35%) were African-American (AA), and 5% were "other" races. AAs were more likely to have Medicaid or be uninsured (44% vs 23%, P = 0. 001) and were more likely to be admitted for an emergency (unadjusted odds ratio (OR) = 1.6; 1.2-2.2), to have a comorbid illness (P = 0.001), to be admitted for a cancer-related complication (P = 0.036), to be admitted for a transfusion (P = 0. 01), and to be admitted for radiation therapy rather than surgery (P = 0.001). The following were associated with LOS and higher hospital costs: emergency admissions for complications of cancer, comorbid illness, and older age.


CONCLUSIONS
Racial differences exist in patterns of admission, type of therapy, and severity of illness; however, there were no differences in charges or LOS for similar procedures. The large percentage of African-Americans uninsured or insured by government-supported programs indicates the potential impact of public policy on the care of these patients. Socioeconomic status rather than phenotypic appearance may be a more important determinant of outcome.
Brooks
S E
SE
Department of Obstetrics and Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland 21201, USA. sbrooks@ummc001.umaryland.edu
Chen
T T
TT
Ghosh
A
A
Mullins
C D
CD
Gardner
J F
JF
Baquet
C R
CR
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D017722:Hospital Charges; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D044469:Racial Groups; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D044465:White People / Q000706:statistics & numerical data