RESUMEN
Whether the African American race remains a significant predictor of poorer prostate cancer survival after adjusting for other sociodemographic and treatment-related factors remains unclear. We examined whether disparities in survival among 18,900 African American and Caucasian men diagnosed with prostate cancer in Kentucky remained after adjusting for health insurance (payor source), cancer treatment, cancer stage at diagnosis, prostate-specific antigen (PSA) level, smoking status, and Appalachian region. After adjusting for these predictors, African American men living in Kentucky had poorer prostate cancer survival after 5 years (hazard ratio [HR] = 1.33; 95% confidence interval = 1.11, 1.59) and 10 years (HR = 1.39; 95% CI = 1.18, 1.28) of follow-up, and for the entire follow-up period (HR = 1.41; 95% CI = 1.26, 1.65) compared to their Caucasian counterparts. Thus, health insurance status, cancer treatment, cancer stage at diagnosis, PSA level at diagnosis, smoking status, and geographic location did not explain the racial gap in survival in Kentucky.
Asunto(s)
Causas de Muerte , Disparidades en Atención de Salud , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/mortalidad , Negro o Afroamericano/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Disparidades en el Estado de Salud , Humanos , Estimación de Kaplan-Meier , Kentucky , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/terapia , Racismo , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores Socioeconómicos , Análisis de Supervivencia , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVES: To identify prognostic factors influencing cervical cancer survival for patients referred to a tertiary care center in Kentucky. METHODS: A cohort study was performed to assess predictive survival factors of cervical cancer patients referred to the University of Kentucky from January 2001 to May 2010. Eligibility criteria included those at least 18 years-old, cervical cancer history, and no prior malignancy. Descriptive statistics were compiled and univariable and multivariable Cox proportional hazard analysis were performed. RESULTS: 381 patients met entry criteria. 95% were Caucasian (N=347) and 66% (N=243) lived in Appalachian Kentucky. The following covariates showed no evidence of a statistical association with survival: race, body mass index, residence, insurance status, months between last normal cervical cytology and diagnosis, histology, tumor grade, and location of primary radiation treatment. After controlling for identified significant variables, stage of disease was a significant predictor of overall survival, with estimated relative hazards comparing stages II, III, and IV to stage I of 3.09 (95% CI: 1.30, 7.33), 18.11 (95% CI: 7.44, 44.06), and 53.03(95% CI: 18.16, 154.87), respectively. The presence of more than two comorbid risk factors and unemployment was also correlated with overall survival [HR 4.25 (95% CI: 1.00, 18.13); HR 2.64 (95% CI 1.29, 5.42), respectively]. CONCLUSIONS: Residence and location of treatment center are not an important factor in cervical cancer survival when a tertiary cancer center can oversee and coordinate care; however, comorbid risk factors influence survival and further exploration of disease comorbidity related to cervical cancer survival is warranted.