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Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study.

Publication ,  Journal Article
Montes de Oca, MK; Chen, Q; Howell, E; Wilson, LE; Meernik, C; Previs, RA; Huang, B; Pisu, M; Liang, MI; Ward, KC; Schymura, MJ; Berchuck, A ...
Published in: JNCI Cancer Spectr
March 1, 2023

BACKGROUND: Racial and ethnic disparities in ovarian cancer (OC) survival are well-documented. However, few studies have investigated how health-care access (HCA) contributes to these disparities. METHODS: To evaluate the influence of HCA on OC mortality, we analyzed 2008-2015 Surveillance, Epidemiology, and End Results-Medicare data. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HCA dimensions (affordability, availability, accessibility) and OC-specific and all-cause mortality, adjusting for patient characteristics and treatment receipt. RESULTS: The study cohort included 7590 OC patients: 454 (6.0%) Hispanic, 501 (6.6%) Non-Hispanic (NH) Black, and 6635 (87.4%) NH White. Higher affordability (HR = 0.90, 95% CI = 0.87 to 0.94), availability (HR = 0.95, 95% CI = 0.92 to 0.99), and accessibility scores (HR = 0.93, 95% CI = 0.87 to 0.99) were associated with lower risk of OC mortality after adjusting for demographic and clinical factors. Racial disparities were observed after additional adjustment for these HCA dimensions: NH Black patients experienced a 26% higher risk of OC mortality compared with NH White patients (HR = 1.26, 95% CI = 1.11 to 1.43) and a 45% higher risk among patients who survived at least 12 months (HR = 1.45, 95% CI = 1.16 to 1.81). CONCLUSIONS: HCA dimensions are statistically significantly associated with mortality after OC and explain some, but not all, of the observed racial disparity in survival of patients with OC. Although equalizing access to quality health care remains critical, research on other HCA dimensions is needed to determine additional factors contributing to disparate OC outcomes by race and ethnicity and advance the field toward health equity.

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Published In

JNCI Cancer Spectr

DOI

EISSN

2515-5091

Publication Date

March 1, 2023

Volume

7

Issue

2

Location

England

Related Subject Headings

  • United States
  • Survival Analysis
  • Racial Groups
  • Ovarian Neoplasms
  • Medicare
  • Humans
  • Health Status Disparities
  • Health Services Accessibility
  • Female
  • Ethnicity
 

Citation

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Montes de Oca, M. K., Chen, Q., Howell, E., Wilson, L. E., Meernik, C., Previs, R. A., … Akinyemiju, T. (2023). Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study. JNCI Cancer Spectr, 7(2). https://doi.org/10.1093/jncics/pkad011
Montes de Oca, Mary Katherine, Quan Chen, Elizabeth Howell, Lauren E. Wilson, Clare Meernik, Rebecca A. Previs, Bin Huang, et al. “Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study.JNCI Cancer Spectr 7, no. 2 (March 1, 2023). https://doi.org/10.1093/jncics/pkad011.
Montes de Oca MK, Chen Q, Howell E, Wilson LE, Meernik C, Previs RA, et al. Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study. JNCI Cancer Spectr. 2023 Mar 1;7(2).
Montes de Oca, Mary Katherine, et al. “Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study.JNCI Cancer Spectr, vol. 7, no. 2, Mar. 2023. Pubmed, doi:10.1093/jncics/pkad011.
Montes de Oca MK, Chen Q, Howell E, Wilson LE, Meernik C, Previs RA, Huang B, Pisu M, Liang MI, Ward KC, Schymura MJ, Berchuck A, Akinyemiju T. Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study. JNCI Cancer Spectr. 2023 Mar 1;7(2).

Published In

JNCI Cancer Spectr

DOI

EISSN

2515-5091

Publication Date

March 1, 2023

Volume

7

Issue

2

Location

England

Related Subject Headings

  • United States
  • Survival Analysis
  • Racial Groups
  • Ovarian Neoplasms
  • Medicare
  • Humans
  • Health Status Disparities
  • Health Services Accessibility
  • Female
  • Ethnicity