title: Racial disparities in ovarian cancer surgical care: a population-based analysis.
abstract: OBJECTIVE
  To investigate differences according to racial classification in the frequency of ovarian cancer-related surgical procedures and in access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer.
  
  
  METHODS
  The Maryland Health Services Cost Review Commission database was accessed for women age >18years undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 7/1/01 and 6/30/09. Multivariate logistic regression analyses were used to evaluate for differences in the likelihood of selected surgical procedures and access to high-volume surgical providers (surgeons≥10 cases/year; hospitals≥20 case/year) according racial classification.
  
  
  RESULTS
  A total of 2487 patients were identified who underwent a primary surgical procedure that included oophorectomy for a malignant ovarian neoplasm: White=1884 (75.4%), African-American=400 (16.1%), and other/unknown=203 (8.2%). Compared to White patients, African-American patients were significantly younger (mean age 55.4years vs 59.9years, P<0.0001) and less likely to have commercial insurance (28.5% vs 39.5%, p<0.0001). Compared to White patients, African-American racial classification was associated with a statistically significant and independent lower likelihood of hysterectomy (OR=0.53, 95%CI=0.42-0.66, p<0.0001), colon resection (OR=0.65, 95%CI=0.48-0.87, p=0.004), lymphadenectomy (OR=0.67, 95%CI=0.50-0.91, p=0.01), and surgery by a high-volume surgeon (OR=0.55, 95%CI=0.44-0.69, p<0.0001).
  
  
  CONCLUSIONS
  Among women undergoing initial surgery for ovarian cancer, African-American patients are significantly less likely to be operated on by a high-volume surgeon and to undergo important ovarian cancer-specific surgical procedures compared to White patients.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA 92868, USA. rbristow@uci.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Okechukwu A
authors.initials: OA
authors.lastname: Ibeanu
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000601:surgery*