Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer Treatment and Mortality: Systematic Review and Meta-Analysis.
Journal
JNCI cancer spectrum
ISSN: 2515-5091
Titre abrégé: JNCI Cancer Spectr
Pays: England
ID NLM: 101721827
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
06
06
2019
revised:
23
09
2019
accepted:
04
10
2019
entrez:
17
12
2019
pubmed:
17
12
2019
medline:
17
12
2019
Statut:
epublish
Résumé
Ovarian cancer remains a leading cause of death from gynecological malignancies. Race, socioeconomic status (SES), and access to health care are important predictors of quality treatment and survival. We provide a systematic review and meta-analysis on the role of these predictors on disparities in ovarian cancer treatment and mortality. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, EMBASE, and Scopus for relevant articles published between January 2000 and March 2017. We selected studies published in the United States that evaluated the role of race, SES, or health-care access on disparities in ovarian cancer treatment or survival. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated for each outcome using a random-effects model. A total of 41 studies met the inclusion criteria for systematic review. In meta-analysis, there was a 25% decrease (RR = 0.75, 95% CI = 0.66 to 0.84) in receipt of adherent ovarian cancer treatment and 18% increased risk (RR = 1.18, 95% CI = 1.11 to 1.26) of mortality for blacks compared to whites. Receipt of adherent ovarian cancer treatment was 15% lower (RR = 0.85, 95% CI = 0.77 to 0.94) in the lowest vs highest SES group and 30% lower (RR = 0.70, 95% CI = 0.58 to 0.85) among patients at lower vs higher hospital volumes. We found consistent and strong evidence for continued lack of quality ovarian cancer treatment and higher mortality among ovarian cancer patients who are black, are of low SES, and/or have poor access to care. Interventions focused on these groups targeting specific barriers to care are needed to reduce disparities in ovarian cancer treatment and mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Ovarian cancer remains a leading cause of death from gynecological malignancies. Race, socioeconomic status (SES), and access to health care are important predictors of quality treatment and survival. We provide a systematic review and meta-analysis on the role of these predictors on disparities in ovarian cancer treatment and mortality.
METHODS
METHODS
Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, EMBASE, and Scopus for relevant articles published between January 2000 and March 2017. We selected studies published in the United States that evaluated the role of race, SES, or health-care access on disparities in ovarian cancer treatment or survival. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated for each outcome using a random-effects model.
RESULTS
RESULTS
A total of 41 studies met the inclusion criteria for systematic review. In meta-analysis, there was a 25% decrease (RR = 0.75, 95% CI = 0.66 to 0.84) in receipt of adherent ovarian cancer treatment and 18% increased risk (RR = 1.18, 95% CI = 1.11 to 1.26) of mortality for blacks compared to whites. Receipt of adherent ovarian cancer treatment was 15% lower (RR = 0.85, 95% CI = 0.77 to 0.94) in the lowest vs highest SES group and 30% lower (RR = 0.70, 95% CI = 0.58 to 0.85) among patients at lower vs higher hospital volumes.
CONCLUSION
CONCLUSIONS
We found consistent and strong evidence for continued lack of quality ovarian cancer treatment and higher mortality among ovarian cancer patients who are black, are of low SES, and/or have poor access to care. Interventions focused on these groups targeting specific barriers to care are needed to reduce disparities in ovarian cancer treatment and mortality.
Identifiants
pubmed: 31840133
doi: 10.1093/jncics/pkz084
pii: pkz084
pmc: PMC6899434
doi:
Types de publication
Journal Article
Langues
eng
Pagination
pkz084Subventions
Organisme : NCI NIH HHS
ID : P30 CA177558
Pays : United States
Organisme : NCI NIH HHS
ID : R37 CA233777
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press.
Références
Gynecol Oncol. 2015 Jul;138(1):121-7
pubmed: 25913132
Obstet Gynecol. 2007 Jun;109(6):1342-50
pubmed: 17540806
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
pubmed: 19622511
Am J Obstet Gynecol. 2015 Jul;213(1):43.e1-43.e8
pubmed: 25644440
Cancer. 2010 Oct 15;116(20):4840-8
pubmed: 20578182
Gynecol Oncol. 2008 Nov;111(2):166-72
pubmed: 18829086
Am Fam Physician. 2016 Jun 1;93(11):937-44
pubmed: 27281838
Cancer. 2002 Mar 15;94(6):1886-93
pubmed: 11920552
Gynecol Oncol. 2014 Jan;132(1):221-6
pubmed: 24016407
Soc Sci Med. 2010 Jul;71(2):274-281
pubmed: 20483517
Biometrics. 1994 Dec;50(4):1088-101
pubmed: 7786990
Obstet Gynecol. 2013 Nov;122(5):1025-32
pubmed: 24104782
Gynecol Oncol. 2011 Aug;122(2):319-23
pubmed: 21632099
Ann Epidemiol. 2015 Aug;25(8):556-63
pubmed: 25986734
Front Public Health. 2015 Jan 22;3:8
pubmed: 25657992
Gynecol Oncol. 2008 Jan;108(1):95-9
pubmed: 17949796
Cancer. 2007 May 15;109(10):2031-42
pubmed: 17420977
CA Cancer J Clin. 2018 Jan;68(1):7-30
pubmed: 29313949
Int J Gynecol Cancer. 2008 Jul-Aug;18(4):660-9
pubmed: 17892451
Gynecol Oncol. 2008 Nov;111(2):173-8
pubmed: 18823649
JAMA Oncol. 2015 Apr;1(1):88-96
pubmed: 26182310
Gynecol Oncol. 2010 Sep;118(3):262-7
pubmed: 20573392
J Clin Oncol. 2002 Jan 1;20(1):173-8
pubmed: 11773167
Popul Health Manag. 2019 Apr;22(2):138-143
pubmed: 30113261
Obstet Gynecol. 2012 Jan;119(1):68-77
pubmed: 22183213
Cancer. 2011 Jul 15;117(14):3242-51
pubmed: 21264829
Am J Obstet Gynecol. 2015 Apr;212(4):468.e1-9
pubmed: 25448522
Clin Cancer Res. 2016 Dec 1;22(23):5909-5914
pubmed: 27521449
Gynecol Oncol. 2013 Apr;129(1):258-64
pubmed: 23266352
Cancer. 2009 Sep 15;115(18):4210-7
pubmed: 19536873
Gynecol Oncol. 2015 Jan;136(1):11-7
pubmed: 25449311
Health Serv Res. 2006 Dec;41(6):2201-18
pubmed: 17116116
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
J Natl Cancer Inst. 2013 Jun 5;105(11):823-32
pubmed: 23539755
Gynecol Oncol. 2014 Feb;132(2):403-10
pubmed: 24361578
Med Care. 1981 Feb;19(2):127-40
pubmed: 7206846
Gynecol Oncol. 2014 Jul;134(1):60-7
pubmed: 24680770
J Clin Oncol. 2003 Sep 15;21(18):3488-94
pubmed: 12972525
Obstet Gynecol. 2015 Apr;125(4):833-42
pubmed: 25751200
Gynecol Oncol. 2011 May 1;121(2):364-8
pubmed: 21288564
Gynecol Oncol. 2003 Dec;91(3):608-15
pubmed: 14675685
Front Oncol. 2016 Feb 22;6:36
pubmed: 26942126
J Natl Cancer Inst. 2009 Jul 15;101(14):984-92
pubmed: 19584328
Obstet Gynecol. 2017 Sep;130(3):545-553
pubmed: 28796677
Gynecol Oncol. 2009 Sep;114(3):437-41
pubmed: 19560191
Psychooncology. 2013 Jan;22(1):83-8
pubmed: 21919121
Gynecol Oncol. 2012 Apr;125(1):19-24
pubmed: 22108636
Gynecol Oncol. 2009 Dec;115(3):339-42
pubmed: 19772939
Gynecol Oncol. 2014 Nov;135(2):285-91
pubmed: 25173584
Gynecol Oncol. 2009 Dec;115(3):334-8
pubmed: 19766295
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120