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Single Marital Status and Infectious Mortality in Women With Cervical Cancer in the United States
  1. Hiroko Machida, MD*,
  2. Sarah E. Eckhardt, MD*,
  3. Antonio V. Castaneda, MD*,
  4. Erin A. Blake, MD,
  5. Huyen Q. Pham, MD*,
  6. Lynda D. Roman, MD*, and
  7. Koji Matsuo, MD, PhD*,
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA;
  2. Department of Obstetrics and Gynecology, University of Colorado, Denver, CO; and
  3. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
  1. Address correspondence and reprint requests to Koji Matsuo, MD, PhD, Division of Gynecologic Oncology Department of Obstetrics and Gynecology, Los Angeles County, Medical Center University of Southern California, 2020 Zonal Ave, IRD520 Los Angeles, CA90089. E-mail: koji.matsuo@med.usc.edu.

Abstract

Objective Unmarried status including single marital status is associated with increased mortality in women bearing malignancy. Infectious disease weights a significant proportion of mortality in patients with malignancy. Here, we examined an association of single marital status and infectious mortality in cervical cancer.

Methods This is a retrospective observational study examining 86,555 women with invasive cervical cancer identified in the Surveillance, Epidemiology, and End Results Program between 1973 and 2013. Characteristics of 18,324 single women were compared with 38,713 married women in multivariable binary logistic regression models. Propensity score matching was performed to examine cumulative risk of all-cause and infectious mortality between the 2 groups.

Results Single marital status was significantly associated with young age, black/Hispanic ethnicity, Western US residents, uninsured status, high-grade tumor, squamous histology, and advanced-stage disease on multivariable analysis (all, P < 0.05). In a prematched model, single marital status was significantly associated with increased cumulative risk of all-cause mortality (5-year rate: 32.9% vs 29.7%, P < 0.001) and infectious mortality (0.5% vs 0.3%, P < 0.001) compared with the married status. After propensity score matching, single marital status remained an independent prognostic factor for increased cumulative risk of all-cause mortality (adjusted hazards ratio [HR], 1.15; 95% confidence interval [CI], 1.11–1.20; P < 0.001) and those of infectious mortality on multivariable analysis (adjusted HR, 1.71; 95% CI, 1.27–2.32; P < 0.001). In a sensitivity analysis for stage I disease, single marital status remained significantly increased risk of infectious mortality after propensity score matching (adjusted HR, 2.24; 95% CI, 1.34–3.73; P = 0.002).

Conclusions Single marital status was associated with increased infectious mortality in women with invasive cervical cancer.

  • Marital status
  • Cervical cancer
  • Infectious disease
  • Survival

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Footnotes

  • Financial support: Ensign Endowment for Gynecologic Cancer Research (K.M.).

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).