title: Socioeconomic status and cervical cancer survival among older women: findings from the SEER-Medicare linked data cohorts.
abstract: OBJECTIVE
  Tumor stage, age, and cell type are well-characterized predictors for cervical cancer survival; socioeconomic factors may also play an important role. The purpose of this study is to estimate cervical cancer survival by socioeconomic indicators and race/ethnicity among elderly women diagnosed with cervical cancer.
  
  
  METHODS
  We studied 1251 women with cervical cancer aged 65 or older, identified between 1992 and 1999 from the Surveillance, Epidemiology, and End Results [SEER]-Medicare linked data. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of socioeconomic status was created using census tract level data for poverty, education, and income. Cox proportional hazard modeling was used for all-cause and cervical cancer-specific survival analysis.
  
  
  RESULTS
  Increased age (P < 0.0001) and advanced tumor stage (<0.0001) were associated with poorer all-cause and cervical cancer-specific survival. After adjustment for age, stage, and treatment, increased co-morbidity scores and having non-squamous cervical cancer were associated with poorer all-cause survival (P < 0.001). After adjusting for confounders, women receiving hysterectomy vs. no surgery or any treatment had significantly better all-cause and cervical cancer-specific survival. Socioeconomic factors were not associated with either all-cause (P for trend = 0.79) or cervical cancer-specific (P for trend = 0.81) survival. No racial/ethnic differences in all-cause or cervical cancer-specific survival were observed after adjusting for socioeconomic factors.
  
  
  CONCLUSIONS
  Among women with similar access to care, neither minority race/ethnicity nor poorer socioeconomic status were associated with poorer survival in this large sample of older women diagnosed with invasive cervical cancer. Presence of co-morbid conditions and treatment were important predictors of cervical cancer survival.
authors.affiliation: School of Public Health, University of Texas, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225, USA. ANN.L.COKER@UTH.TMC.EDU
authors.forename: Ann L
authors.initials: AL
authors.lastname: Coker
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
authors.forename: Shenying
authors.initials: S
authors.lastname: Fang
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Eggleston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006278:Medicare; D016016:Proportional Hazards Models; D018426:SEER Program; D012923:Social Class; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*