Archived
This content is available here for research, reference, and/or recordkeeping.
Abstract
Racial differences in health care access (HCA) may contribute to disparities in ovarian cancer (OC) survival. We used structural equation models (SEMs) to examine associations between race and HCA domains (affordability, availability, accessibility) in relation to overall and OC-specific mortality. Non-Hispanic (NH)–Black and non-Black (Hispanic, NH-White) women diagnosed with OC in 2008-2015 were identified from Surveillance, Epidemiology, and End Results–Medicare. Cox proportional hazards regression was used to conduct mediation analysis for associations between race and HCA domains with overall and OC-specific mortality. SEM models adjusting for demographic and clinical covariates were used to estimate hazard ratios (HRs) and 95% CIs. A total of 4629 eligible patients with OC were identified, including 255 (5.5%) patients who were NH-Black. In SEM adjusting for demographic, clinical, and HCA latent variables, there was a total effect of NH-Black race on overall (HR, 1.11, 95% CI, 1.03-1.19) and OC-specific mortality (HR, 1.16; 95% CI, 1.08, 1.24), which was primarily driven by a direct effect. There was a modest indirect association between NH-Black race and mortality through decreased treatment receipt, though not through HCA. There is a need for studies investigating additional social and biological mechanisms that contribute to worse cancer survival among NH-Black patients.
Document Type
Article
Publication Date
2025
Digital Object Identifier (DOI)
https://doi.org/10.1093/aje/kwae404
Funding Information
This research was funded by the National Institutes of Health/National Cancer Institute (Grant number R37CA233777; PI: Dr. Tomi Akinyemiju).
Repository Citation
Meernik, Clare; Chen, Quan; Wilson, Lauren E.; Joshi, Ashwini; Rahman, Fariha; Pisu, Maria; Liang, Margaret; Ward, Kevin C.; Kuliszewski, Margaret Gates; Tucker, Thomas; Berchuck, Andrew; Huang, Bin; and Akinyemiju, Tomi, "Health care access domains and treatment as mediators of ovarian cancer racial disparities in survival: a structural equation modeling analysis in SEER-Medicare" (2025). Markey Cancer Center Faculty Publications. 489.
https://uknowledge.uky.edu/markey_facpub/489
Notes/Citation Information
© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.