Racial/ethnic, area socioeconomic, and geographic disparities of cervical cancer survival in Texas

A better understanding about the factors associated with cervical cancer survival disparities is an important step in developing more effective cervical cancer intervention strategies. This study investigates cervical cancer survival disparities from three different perspectives based on data from the Texas Cancer Registry from 1995 to 2005. These perspectives are race/ethnicity, area socioeconomic status (SES), and geographic locations. We examined the role of both individual- and contextual-level factors in cervical cancer survival disparities using a multilevel survival analysis. Individual-level factors included race/ethnicity, age at diagnosis, year of diagnosis, tumor grade, stage at diagnosis, and type of treatment received. Contextual-level factors are census-tract-level variables, including demographic characteristics, health insurance expenditure, behavioral factors, extent of urbanization, and spatial access to primary care physicians. This study reveals that African-Americans had a higher mortality risk (HR, 1.19; 95% CI, 1.03-1.38) especially if stage was unknown (HR, 1.72; 95% CI, 1.08-2.75) compared with non-Hispanic whites. Among women diagnosed at regional or distant stage, Hispanics had a survival advantage over their non-Hispanic white counterparts (HR, 0.80; 95% CI, 0.69-0.94). We also identified geographic areas where longer-than-expected or shorter-than-expected cervical cancer survival was statistically significant. Only a small portion of these disparities were explained by individual- and contextual-level factors. This study suggests that Race/Ethnicity, SES, and geography are associated with cervical cancer survival in Texas.