title: Impact of community disadvantage and air pollution burden on geographic disparities of ovarian cancer survival in California.
abstract: Ovarian cancer survival varies geographically throughout California. The objective of this study is to determine the impact of living in disadvantaged communities on spatial patterns of survival disparities. Including a bivariate spatial smooth of geographic location within the Cox proportional hazard models is an effective approach for spatial analyses of cancer survival. Women diagnosed with advanced Stage IIIC/IV epithelial ovarian cancer (1996-2006) were identified from the California Cancer Registry. The impact of living in disadvantaged communities, as measured by the California Office of Environmental Health Hazard Assessment cumulative CalEnviroScreen 2.0 score, on geographic disparities in survival was assessed while controlling for age, tumor characteristics, quality of care, and race. Community-level air quality indicators and socioeconomic status (SES) were also independently examined in secondary analyses. The Cox proportional hazard spatial methods are available in the MapGAM package implemented in R. An increase in the community disadvantage from the 5th (less disadvantage) to the 95th percentile (more disadvantage) was significantly associated with poorer ovarian cancer survival (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.07-1.26). Ozone levels and SES were the most influential indicators on geographic disparities that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential air quality-related predictors of geographic disparities.
authors.affiliation: Program in Public Health, College of Health Sciences, University of California, Irvine, CA, United States; Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, United States. Electronic address: vvieira@uci.edu.
authors.forename: Verónica M
authors.initials: VM
authors.lastname: Vieira
authors.affiliation: Program in Public Health, College of Health Sciences, University of California, Irvine, CA, United States.
authors.forename: Carolina
authors.initials: C
authors.lastname: Villanueva
authors.affiliation: Department of Epidemiology, School of Medicine, University of California, Irvine, CA, United States.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, School of Medicine, University of California, Irvine, CA, United States.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ziogas
authors.affiliation: Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, United States; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, United States.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000633:toxicity*; D002140:California / Q000453:epidemiology; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D005742:Gasoline / Q000633:toxicity; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000139:chemically induced / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000139:chemically induced / Q000401:mortality*; D010126:Ozone / Q000633:toxicity*; D052638:Particulate Matter / Q000633:toxicity*; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012923:Social Class; D001335:Vehicle Emissions / Q000633:toxicity*
chemical_list: D000393:Air Pollutants; D005742:Gasoline; D052638:Particulate Matter; D001335:Vehicle Emissions; D010126:Ozone
keywords: Air pollution burden; Geographic location; MapGAM; Ovarian cancer survival; Ozone