title: The effect of neighborhood-level socioeconomic status on racial differences in ovarian cancer treatment in a population-based analysis in Chicago.
abstract: BACKGROUND
  Less than half of women with ovarian cancer and blacks specifically receive therapy adherent to National Comprehensive Cancer Network (NCCN) guidelines. The purpose is to assess the effect of neighborhood-level socioeconomic status (SES) on black-white treatment differences in a population-based analysis in a highly-segregated community.
  
  
  METHODS
  Illinois State Cancer Registry data for invasive epithelial ovarian cancer cases diagnosed in Cook County, IL in non-Hispanic white (NHW) or black (NHB) women from 1998 to 2009 was analyzed. As few women receive NCCN-adherent care, variables were constructed to assess extent of treatment, including receipt of: 1) debulking surgery; 2) any surgery; 3) multi-agent chemotherapy; and 4) any chemotherapy. Two measures (concentrated affluence and disadvantage) were used to estimate neighborhood-level SES. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (95% CI), with generalized linear mixed models to account for hierarchical data.
  
  
  RESULTS
  2766 (81.0%) NHW and 647 (19.0%) NHB women were diagnosed. Adjusting for covariates, NHB were less likely to receive debulking surgery (OR: 0.39; 95% CI: 0.30-0.50), any surgery (OR: 0.38; 95%CI: 0.29-0.49), multi-agent chemotherapy (OR: 0.56; 95% CI: 0.45-0.71) and any chemotherapy (OR: 0.58; 95% CI: 0.45-0.74). Concentrated affluence but not disadvantage was significant in final models for multi-agent and any chemotherapy, but not debulking or any surgery.
  
  
  CONCLUSIONS
  Results identify black-white differences consistent across treatments that persist despite adjustment for neighborhood-level SES.
  
  
  CONCLUSIONS
  Results advance inequality awareness beyond "ideal" NCCN-adherent care, indicating inequality exists in delivery of even the most basic oncologic care.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, United States; University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, United States. Electronic address: charjosl@uic.edu.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Joslin
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, United States.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Brewer
authors.affiliation: School of Public Health, University of Alberta, Canada.
authors.forename: Faith G
authors.initials: FG
authors.lastname: Davis
authors.affiliation: University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, United States; Department of Hematology/Oncology, University of Illinois at Chicago, United States.
authors.forename: Kent
authors.initials: K
authors.lastname: Hoskins
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, United States.
authors.forename: Caryn E
authors.initials: CE
authors.lastname: Peterson
authors.affiliation: Institute for Health Research and Policy (IHRP), University of Illinois at Chicago, United States.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Pauls
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077216:Carcinoma, Ovarian Epithelial; D002641:Chicago; D065426:Cytoreduction Surgical Procedures / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000628:therapy*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D010385:Pelvic Exenteration / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012111:Residence Characteristics; D012923:Social Class; D044465:White People / Q000706:statistics & numerical data*
keywords: Comorbidities; Neighborhood socioeconomic status; Ovarian cancer; Racial disparities; Treatment