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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3102.0: Monday, December 12, 2005 - 10:30 AM

Abstract #102690

Ethnicity, Poverty, Rural Residence and Cervical Cancer Survival in Texas, 1995-2001

Katherine Eggleston, MSPH1, Ann Coker, PhD2, Melanie Williams, PhD3, Guillermo Tortolero-Luna, MD, PhD4, Jeanne Martin, PhD2, and Susan R. Tortolero, PhD5. (1) Epidemiology, University of Texas School of Public Health at Houston, 1200 Herman Pressler, Houston, TX 77030, 713-500-9955, kathie.eggleston@sbcglobal.net, (2) School of Public Health, University of Texas, PO Box 20186, Houston, TX 77225, (3) Cancer Registry Division, Texas Department of Health, 1100 West 49th Street, Austin, TX 78756, (4) Center for Health Promotion Research and Development, University of Texas Houston, 1200 Herman Pressler, School of Public Health, Houston, TX 77030, (5) Center for Health Promotion Research and Development, University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX 77030

Abstract Background: A racial and/or socioeconomic disparity has been suggested for cervical cancer. The current study explored whether poverty, rural residence, and race/ethnicity may be linked to poor cervical cancer survival by stage of diagnosis. Methods: Data from 7,718 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were utilized to address the association by stage at diagnosis and cause of death. Zip code-level U.S. Census 2000 data were used to classify poverty and rural residence. Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: Late stage of diagnosis was a strong predictor of cervical cancer mortality (HR = 4.3, 95% CI =3.8-4.8). Adjusting for confounders, Hispanic women had lower probability of dying from any cause during the follow-up period (HR=0.66, 95% CI=0.58-0.74). Women residing in areas with greater poverty (>20.5% living at or below poverty) had significantly shorter survival time even when diagnosed at an early stage (HR=1.6, 95% CI=1.2-2.1) or late stage (HR= 1.2 95% CI=1.1-1.4). Living in a rural area was associated with shorter survival time in a dose-dependent manner only for those diagnosed at a late stage (p=0.02). Conclusions: Poverty (p<0.0001), race/ethnicity (0<0.0001), and rural residence (p=0.009) were all independently associated with cervical cancer survival in this large Texas sample. Improved methods of individual classification of poverty status, as well as acquisition of accurate treatment data are needed to better understand these results.

Learning Objectives:

Keywords: Cancer Prevention, Cervical Cancer

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Cancer Epidemiology

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA