Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001.
OBJECTIVE
The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis.


METHODS
Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI).


RESULTS
Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR = 6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR = 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR = 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race.


CONCLUSIONS
SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival.
Eggleston
Katherine S
KS
School of Public Health, University of Texas Health Science Center, Houston, Texas 77225, USA. katherine.s.eggleston@uth.tmc.edu
Coker
Ann L
AL
Williams
Melanie
M
Tortolero-Luna
Guillermo
G
Martin
Jeanne B
JB
Tortolero
Susan R
SR
D000328:Adult; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013781:Texas / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000401:mortality*; D016387:Women's Health