Skip to main content

Advertisement

Log in

Racial/ethnic and socioeconomic disparities in mortality among women diagnosed with cervical cancer in New York City, 1995–2006

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Background

Though cervical cancer rates have declined due to Pap screening, racial and socioeconomic disparities in cervical cancer incidence and mortality persist. This study assesses the relative impact of race/ethnicity and neighborhood poverty on cervical cancer incidence and mortality in New York City (NYC).

Methods

Invasive cervical cancer cases in NYC from 1995 to 2006 were identified along with demographic and socioeconomic measures. Odds ratios (OR) of late stage diagnosis were estimated using logistic regression. Hazard ratios (HR) of death were calculated using Cox proportional hazards regression.

Results

From 1995 to 2006 cervical cancer incidence and mortality rates decreased in NYC, though black and Hispanic women had higher incidence and mortality rates than white women. Puerto Ricans (OR = 1.55, 95% CI = 1.20–2.01) and blacks (OR = 1.34, 95% CI = 1.15–1.57) were more likely to be diagnosed with late stage disease than whites. In multivariate analysis, blacks had similar mortality risk (HR 1.07, 95% CI = 0.95–1.20) to whites while Puerto Ricans had increased risk (HR = 1.31, 95% CI = 1.10–1.55), and non-Puerto Rican Hispanics (HR = 0.54, 95% CI = 0.45–0.63) and Asian/PIs (HR = 0.64, 95% CI = 0.52–0.78) had reduced risk. Women living in high poverty neighborhoods had higher mortality than women in higher income neighborhoods (HR = 1.32, 95% CI = 1.16–1.52).

Conclusions

Black and Puerto Rican women in NYC are at greatest risk of dying from cervical cancer. Race/ethnicity is predictive of late stage diagnosis, while both race/ethnicity and neighborhood poverty are important predictors of cervical cancer mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society (2008) Cancer facts and figures

  2. Garner EIO (2003) Cervical cancer: disparities in screening, treatment, and survival. Cancer Epidemiol Biomarkers Prev 12(3):242s–247

    PubMed  Google Scholar 

  3. Ries L, Melbert D, Krapcho M, Stinchcomb D, Howlander N, Horner M et al. (2008) SEER cancer statistics review, 1975–2005. National Cancer Institute. Bethesda, MD. Based on November 2007 SEER data submission, posted to the SEER website 2008; Available at: http://seer.cancer.gov/csr/1975_2005/. Accessed 08, 2008

  4. del Carmen MG, Montz FJ, Bristow RE, Bovicelli A, Cornelison T, Trimble E (1999) Ethnic differences in patterns of care of Stage 1A1 and Stage 1A2 cervical cancer: A SEER database study. Gynecologic Oncol 75(1):113–117

    Article  CAS  Google Scholar 

  5. Downs LS, Smith JS, Scarinci I, Flowers L, Parham G (2008) The disparity of cervical cancer in diverse populations. Gynecologic Oncol 109(2, Suppl 1):S22–S30

    Google Scholar 

  6. Shavers VL, Brown ML (2002) Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 94(5):334–357

    Google Scholar 

  7. Karpati A, Kerker B, Mostashari F, Singh T, Hajat A, Thorpe L et al (2004) Health disparities in New York City. New York City Department of Health and Mental Hygiene, New York

    Google Scholar 

  8. Kerker B, Kim M, Mostashari F, Thorpe L, Friedan T (2005) Women at risk: the health of women in New York City. New York City Department of Health and Mental Hygiene, New York

    Google Scholar 

  9. Wang JH, Sheppard VB, Schwartz MD, Liang W, Mandelblatt JS (2008) Disparities in cervical cancer screening between Asian American and Non-Hispanic White women. Cancer Epidemiol Biomark Prev 17(8):1968–1973

    Article  Google Scholar 

  10. Klein RJ, Schoenborn CA (2001) Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. National Center for Health Statistics, Hyattsville, MD

  11. Efron B (1977) The efficiency of Cox’s likelihood function for censored data. J Am Stat Ass 72:557–565

    Article  Google Scholar 

  12. Gallagher B, Wang Z, Schymura MJ, Kahn A, Fordyce EJ (2001) Cancer incidence in New York State acquired immunodeficiency syndrome patients. Am J Epidemiol 154(6):544–556

    Article  CAS  PubMed  Google Scholar 

  13. Akers AY, Newmann SJ, Smith JS (2007) Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Curr Probl Cancer 31(3):157–181

    Article  PubMed  Google Scholar 

  14. Bates JH, Hofer BM, Parikh-Patel A (2008) Cervical cancer incidence, mortality, and survival among Asian subgroups in California, 1990–2004. Cancer 113(10):2955–2963

    Article  PubMed  Google Scholar 

  15. Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LAG et al. (2005) Annual report to the Nation on the Status of Cancer, 1975–2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst 97(19):1407–1427

    Google Scholar 

  16. Zapka JG, Taplin SH, Solberg LI, Manos MM (2003) A framework for improving the quality of cancer care. Cancer Epidemiol Biomarkers Prev 12(1):4–13

    PubMed  Google Scholar 

  17. Yabroff KR, Washington KS, Leader A, Neilson E, Mandelblatt J (2003) Is the promise of cancer-screening programs being compromised? Quality of follow-up care after abnormal screening results. Med Care Res Rev 60(3):294–331

    Google Scholar 

  18. Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS et al (2007) Prevalence of HPV infection among females in the United States. JAMA 297(8):813–819

    Article  CAS  PubMed  Google Scholar 

  19. Spence AR, Goggin P, Franco EL (2007) Process of care failures in invasive cervical cancer: systematic review and meta-analysis. Prev Med 45(2–3):93–106

    Article  PubMed  Google Scholar 

  20. Olson E, Van Wye G, Kerker B, Thorpe L (2006) Cervical cancer screening in New York City. NYC Vital Signs 5(3):1–4

    Google Scholar 

  21. Vernon SW, Briss PA, Tiro JA, Warnecke RB (2004) Some methodologic lessons learned from cancer screening research. Cancer 101(S5):1131–1145

    Google Scholar 

  22. Coker AL, Du XL, Fang S, Eggleston KS (2006) Socioeconomic status and cervical cancer survival among older women: Findings from the SEER–Medicare linked data cohorts. Gynecol Oncol 102(2):278–284

    Google Scholar 

  23. Johnson CE, Mues KE, Mayne SL, Kiblawi AN (2008) Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the health belief model. J Lower Genital Tract Disease 12(3):232–241

    Article  Google Scholar 

  24. Benard VB, Lawson HW, Eheman CR, Anderson C, Helsel W (2005) Adherence to guidelines for follow-up of low-grade cytologic abnormalities among medically underserved women. Obstet Gynecol 105(6):1323–1328

    PubMed  Google Scholar 

  25. Newmann SJ, Garner EO (2005) Social inequities along the cervical cancer continuum: a structured review. Cancer Causes Control 16(1):63–70

    Article  PubMed  Google Scholar 

  26. Patel DA, Barnholtz-Sloan JS, Patel MK, Malone J, John M, Chuba PJ, Schwartz K (2005) A population-based study of racial and ethnic differences in survival among women with invasive cervical cancer: analysis of surveillance, epidemiology, and end results data. Gynecol Oncol 97(2):550–558

    Article  PubMed  Google Scholar 

  27. Eggleston KS, Coker AL, Williams M, Tortolero-Luna G, Martin JB, Tortolero SR (2006) Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995–2001. J Women’s Health 15(8):941–951

    Article  Google Scholar 

  28. Leath III CA, Straughn J, Michael J, Kirby TO, Huggins A, Partridge EE, Parham GP (2005) Predictors of outcomes for women with cervical carcinoma. Gynecologic Oncol 99(2):432–436

    Google Scholar 

  29. Thoms W, Unger E, Johnson P, Spann C, Hunter S, Smith R et al (1995) Cervical cancer survival in a high risk urban population. Cancer 76(12):2518–2523

    Article  CAS  PubMed  Google Scholar 

  30. Brookfield KF, Cheung MC, Lucci J, Fleming LE, Koniaris LG (2009) Disparities in survival among women with invasive cervical cancer. Cancer 115(1):166–178

    Article  PubMed  Google Scholar 

  31. Movva S, Noone A, Banerjee M, Patel D, Schwartz K, Yee C et al (2008) Racial differences in cervical cancer survival in the Detroit metropolitan area. Cancer 112(6):1264–1271

    Article  PubMed  Google Scholar 

  32. Singh GK, Miller BA, Hankey BF, Edwards BK (2004) Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000. Cancer 101(5):1051–1057

    Article  PubMed  Google Scholar 

  33. Lin S, Clarke C, Prehn A, Glaser S, West D, O’Malley C (2002) Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas. Cancer 94(4):1175–1182

    Article  PubMed  Google Scholar 

  34. Abraído-Lanza AF, Chao MT, Flórez KR (2005) Do healthy behaviors decline with greater acculturation?: implications for the Latino mortality paradox. Soc Sci Med 61(6):1243–1255

    Google Scholar 

  35. Lobo AP, Flores RJO, Salvo JJ (2002) The impact of Hispanic growth on the racial/ethnic composition of New York City neighborhoods. Urban Aff Rev 37(5):703–727

    Google Scholar 

  36. Lara M, Gamboa C, Kahramanian MI, Morales LS, Hayes Bautista DE (2005) Acculturation and latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health 26(1):367–397

    Google Scholar 

  37. Singh G, Miller B, Hankey B, Edwards B (2004) Persistent area socioeconomic disparities in US incidence of cervical cancer, mortality, stage, and survival, 1975–2000. Cancer 101(5):1051–1057

    Google Scholar 

  38. Krieger N, Chen JT, Waterman PD, Soobader M, Subramanian SV, Carson R (2002) Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the public health disparities geocoding project. Am J Epidemiol 156(5):471–482

    Google Scholar 

Download references

Acknowledgments

We thank Pei-Chi Chung, MD, Lorna Thorpe, Ph.D., Lynn Silver, MD, MPH, and the staff of the Bureau of Chronic Disease Prevention & Control and the Health Research Training Program at the NYC Department of Health and Mental Hygiene for their advice and cooperation on this project. Dr. Visvanathan is a recipient of an American Society of Clinical Oncology (ASCO) Career Development Award and a KO7 Preventive Oncology Academic Award (CA111948) from the National Cancer Institute.

Grant support

Funding for this project was provided by the Josiah Macy, Jr. Foundation through the NYC Epi Scholars Program at the NYC Department of Health and Mental Hygiene.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne Marie McCarthy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCarthy, A.M., Dumanovsky, T., Visvanathan, K. et al. Racial/ethnic and socioeconomic disparities in mortality among women diagnosed with cervical cancer in New York City, 1995–2006. Cancer Causes Control 21, 1645–1655 (2010). https://doi.org/10.1007/s10552-010-9593-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-010-9593-7

Keywords

Navigation