title: Race, epithelial ovarian cancer survival, and membership in a large health maintenance organization.
abstract: BACKGROUND
  African-American ovarian cancer patients present with more advanced disease and have poorer survival than do white patients.
  
  
  METHODS
  To determine whether these differences occur among African-American and white patients who have equal access to medical care, we analyzed ovarian cancer patient characteristics separately for 1,587 members of the Kaiser Permanente Medical Plan of Northern California and 5,757 non-members.
  
  
  RESULTS
  The distributions of disease stage at diagnosis were similar among African-American and white patients, both in the Kaiser plan and elsewhere. However, ovarian cancer death rates, adjusted for disease stage and age at diagnosis and for histology, were higher for African-American patients compared with white patients, regardless of Kaiser membership status. The death rate ratios for African-Americans compared with whites were 1.32 (95% CI = 1.02-1.70) for Kaiser members and 1.20 (95% CI = 1.04-1.40) for Kaiser non-members.
  
  
  CONCLUSIONS
  Further research within an equal-access care system is needed to evaluate other important factors such as specialty of surgeon, extent of residual tumor after surgery, chemotherapy treatment, and postoperative management to determine whether these factors are contributing to the differences in survival between African-American and white ovarian cancer patients.
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5405, USA. vmcguire@leland.stanford.edu
authors.forename: Valerie
authors.initials: V
authors.lastname: McGuire
authors.forename: Lisa
authors.initials: L
authors.lastname: Herrinton
authors.forename: Alice S
authors.initials: AS
authors.lastname: Whittemore
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000401:mortality; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data