Cervical cancer is an entirely preventable disease yet in Texas approximately 1200 women are newly diagnosed and 300 die with this disease per year. Several recent studies suggest that poverty not minority ethnicity may be an important predictor of poor survival particularly for those diagnosed at an early stage. The purpose of this project is to explore disparities in cervical cancer stage at diagnosis, treatment and survival in Texas, a large state with great ethnic, income, and rural / urban diversity. We propose a population-based cohort study of all women diagnosed with cervical cancer and reported to the Texas Cancer Registry (TCR) between 1995-2002 (N>8800 women). Specific Aims are (1) To determine whether women of minority race or ethnicity (Asian, Hispanic, and African-American relative to White), those with lower income or education, and those living in more rural regions among women diagnosed with CxCa are more likely to die or have shorter survival, stratified by tumor stage. (2) To determine to what extent the differences in survival experienced by women of diverse ethnicity, income, or rurality can be explained by their treatment received, tumor stage at diagnosis or comorbid conditions. We plan to use (a) geocoded data to allow a more precise census tract level measures of socio-economic status and (b) multiple sources of cancer treatment data (Texas Medicaid, Medicare, and Hospital Discharge merged with TCR cancer and mortality data). A conceptual model is proposed to assess the role of disparities in (1) cervical cancer surivival, (2) intermediate outcomes (late stage at diagnosis and suboptimal treatment), and (3) comorbid conditions. Multilevel logistic regression and Cox proportional hazards modeling are planned to estimate the risk of mortality and survival time, respectively. This R21 will provide pre-intervention data to identify those disparities indicators which should be the target of aggressive individual and health care provider level interventions to identify cervical cancer early and get women needed effective treatment in a timely manner.
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