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Sociodemographic characteristics and cervical cancer survival in different regions of the United States: a National Cancer Database study
  1. Michael D Toboni1,2,
  2. Alexander Cohen1,2,
  3. Zachary L Gentry2,
  4. Stuart A Ostby2,
  5. Zhixin Wang3,
  6. Sejong Bae3 and
  7. Charles Leath2
  1. 1Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  2. 2Department of Obstetrics and Gynecology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
  3. 3Department of Preventive Medicine, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
  1. Correspondence to Dr Michael D Toboni, Washington University in St Louis, St Louis, MO 63130, USA; MDToboni{at}wustl.edu

Abstract

Objective To determine how sociodemographic factors impact cervical cancer survival in different geographic locations in the USA.

Methods A retrospective cohort of patients with cervical cancer from January 1, 2004 to December 31, 2015 in the National Cancer Database (NCDB) was identified. Tumor characteristics as well as race, income, insurance type, and treating facility types were compared among nine geographic regions. χ2 tests and Cox regression were used to compare differences between regions; p values <0.05 were considered significant.

Results A total of 48 787 patients were included. Survival was inferior in seven of nine regions for underinsured patients. In six regions survival was inferior for Medicaid and Medicare patients, respectively: Middle Atlantic: hazard ratio (HR) 1.25 and 1.22; South Atlantic: HR 1.41 and HR 1.22; East North Central: HR 1.36 and HR 1.25; East South Central: HR 1.37 and HR 1.25; West North Central: HR 1.67 and HR 1.42; West South Central: HR 1.44 and HR 1.46. In the Pacific region survival was inferior for Medicare patients (HR 1.35) but not inferior for Medicaid patients. Being uninsured was associated with worse survival in the South Atlantic (HR 1.23), East North Central (HR 1.23), East South Central (HR 1.56), and West South Central (HR 1.31) regions. Annual income level under $38 000 was associated with worse survival in the Middle Atlantic (HR 1.24), South Atlantic (HR 1.35), and East North Central (HR 1.49) regions. Lastly, when compared with academic research institutions, comprehensive community cancer centers had significantly worse survival in four of the nine regions.

Conclusions Cervical cancer mortality is higher for women with a low income, underinsured (Medicaid or Medicare) or uninsured status, and decreased access to academic institutions in most US regions. An increase in cervical cancer mortality was associated with underinsured or uninsured populations in regions mainly located in the South and Midwest.

  • Cervical Cancer
  • Cervix Uteri

Data availability statement

Data may be obtained from a third party and are not publicly available. Data was obtained from the National Cancer Database. In accordance with the journal’s guidelines, public use data are available at https://www.facs.org/quality-programs/cancer/ncdb/puf and SAS analyzed data can be provided for the reproducibility of this study if such is requested.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data was obtained from the National Cancer Database. In accordance with the journal’s guidelines, public use data are available at https://www.facs.org/quality-programs/cancer/ncdb/puf and SAS analyzed data can be provided for the reproducibility of this study if such is requested.

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Footnotes

  • Twitter @TabonesMT

  • Contributors All authors made substantial contributions to the conception and design of the work; acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MT is responsible for the overall content as the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding SB was supported in part by P30 CA13148 and P50 CA098252 while CL was supported in part by the UG1 CA23330 and P50 CA098252. These funding sources are from the National Cancer Institute (NCI). CL reports contracted research with Agenus.

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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