title: Racial disparities and patterns of ovarian cancer surgical care in California.
abstract: OBJECTIVE
  To investigate disparities in the frequency of ovarian cancer-related surgical procedures and access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer according to race.
  
  
  METHODS
  The California Office of Statewide Health Planning and Development database was accessed for women undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 1/1/06 and 12/31/10. Multivariate logistic regression analyses were used to evaluate differences in the odds of selected surgical procedures and access to high-volume centers (hospitals ≥ 20 cases/year) according to racial classification.
  
  
  RESULTS
  A total of 7933 patients were identified: White = 5095 (64.2%), Black = 290 (3.7%), Hispanic/Latino = 1400 (17.7%), Asian/Pacific Islander = 836 (10.5%) and other = 312 (3.9%). White patients served as reference for all comparisons. All minority groups were significantly younger (Black mean age 57.7 years, Hispanic 53.2 years, Asian 54.5 years vs. 61.1 years, p < 0.01). Hispanic patients had lower odds of obtaining care at a high-volume center (adjusted OR (adj. OR) = 0.72, 95% CI = 0.64-0.82, p < 0.01) and a lower likelihood of lymphadenectomy (adj. OR = 0.80, 95% CI=0.70-0.91, p<0.01), bowel resection (adj. OR = 0.80, 95% CI = 0.71-0.91, p < 0.01), and peritoneal biopsy/omentectomy (adj. OR = 0.69, 95% CI = 0.58-0.82, p<0.01). Black racial classification was associated with a lower likelihood of lymphadenectomy (adj. OR = 0.76, 95% CI = 0.59-0.97, p = 0.03).
  
  
  CONCLUSIONS
  Among women undergoing initial surgery for ovarian cancer, Hispanic patients are significantly less likely to be operated on at a high-volume center, and both Black and Hispanic patients are significantly less likely 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 Medical Center, Orange, CA, USA.
authors.forename: F W
authors.initials: FW
authors.lastname: Liu
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Randall
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Tewari
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People; D044383:Black People; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000601:surgery*; D044465:White People
keywords: Ovarian cancer; Racial disparities
references.citation: Gynecol Oncol. 2006 Nov;103(2):559-64
references.pmid: 16714056
references.citation: Gynecol Oncol. 2008 Nov;111(2):166-72
references.pmid: 18829086
references.citation: Gynecol Oncol. 2009 Jul;114(1):26-31
references.pmid: 19395008
references.citation: Gynecol Oncol. 2011 Aug;122(2):319-23
references.pmid: 21632099
references.citation: Gynecol Oncol. 2010 Apr;117(1):18-22
references.pmid: 20106512
references.citation: Obstet Gynecol. 2012 Jan;119(1):68-77
references.pmid: 22183213
references.citation: Gynecol Oncol. 2013 Apr;129(1):258-64
references.pmid: 23266352
references.citation: J Natl Cancer Inst. 2013 Jun 5;105(11):823-32
references.pmid: 23539755
references.citation: Cancer Epidemiol Biomarkers Prev. 2013 Jan;22(1):25-31
references.pmid: 23125334
references.citation: Gynecol Oncol. 2011 May 1;121(2):364-8
references.pmid: 21288564
references.citation: CA Cancer J Clin. 2007 Jul-Aug;57(4):190-205
references.pmid: 17626117
references.citation: Med Care. 2006 Jul;44(7):687-95
references.pmid: 16799364
references.citation: Gynecol Oncol. 2002 Dec;87(3):260-7
references.pmid: 12468323
references.citation: Gynecol Oncol. 2012 Apr;125(1):19-24
references.pmid: 22108636
references.citation: J Immigr Minor Health. 2014 Jun;16(3):429-39
references.pmid: 23315046
references.citation: Cancer Causes Control. 2009 Sep;20(7):1139-50
references.pmid: 19288217
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: Cancer Epidemiol Biomarkers Prev. 2013 Feb;22(2):233-41
references.pmid: 23239812
references.citation: Int J Gynecol Cancer. 2008 Jul-Aug;18(4):660-9
references.pmid: 17892451
references.citation: Gynecol Oncol. 2008 Nov;111(2):173-8
references.pmid: 18823649
references.citation: Ann Surg Oncol. 2008 Feb;15(2):415-23
references.pmid: 17987343
references.citation: Gynecol Oncol. 2010 Sep;118(3):262-7
references.pmid: 20573392
references.citation: Cancer. 2009 Sep 15;115(18):4210-7
references.pmid: 19536873
references.citation: Am J Public Health. 2009 Feb;99(2):300-7
references.pmid: 19059854
references.citation: CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
references.pmid: 18287387
references.citation: J Surg Oncol. 2008 Feb 1;97(2):103-7
references.pmid: 17979133
references.citation: Ann Surg Oncol. 2012 Dec;19(13):4059-67
references.pmid: 22766983
references.citation: Gynecol Oncol. 2009 Nov;115(2):199-203
references.pmid: 19695688
references.citation: Gynecol Oncol. 2007 Jun;105(3):801-12
references.pmid: 17433422
references.citation: CA Cancer J Clin. 2013 Jan;63(1):11-30
references.pmid: 23335087
references.citation: Am J Obstet Gynecol. 2003 Oct;189(4):1120-7
references.pmid: 14586365