142nd APHA Annual Meeting and Exposition

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297788
Demographic Predictors of Delayed-stage Diagnosis of Cervical Cancer

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 8:30 AM - 8:50 AM

John W. Morgan, DrPH, CPH , Department of Epidemiology, Biostatistics and Population Medicine, Loma Linda University, School of Public Health and SEER Cancer Registry of Greater California, Loma Linda, CA
Sepideh Saghuri, MPH , School Of Public Health, Loma Linda University, Loma Linda, CA
Mark Ghamsary, PhD , Department of Epidemiology, Biostatistics & Population Medicine, Loma Linda University School of Public health, Loma Linda, CA
Arian Marie-Mitchell, MD, PhD , Family Medicine, School of Medicine, Loma Linda University, Loma Linda, CA
Audio (mp3) recording Recorded Presentation (mp4)
INTRODUCTION: Hispanics experience highest cervical adeno- and epidermoid-carcinoma(CACX) risk, followed by non-Hispanic blacks (NHB), Asian/others and Non-Hispanic whites (NHW). The California Cancer Registry (CCR) is the statewide population-based cancer reporting system, composing the three largest SEER registries.

METHODS: We conducted a non-concurrent cohort investigation assessing independent roles of age, race-ethnicity, socioeconomic status (SES), and marital status as predictors of stage II-IV (delayed-) versusstage I (early-) CACX.

FINDINGS: Among 5,324 early-stage and 5,222 delayed-stage CACX cases in the CCR from 1996-2005, 61.8% were among women age 50+ years. Logistic regression adjusted odds ratios (OR) with 95% confidence intervals (OR, 95% CI) contrasting delayed-stage versus early-stage CACX for age-categories revealed a significant upward trend with increasing age-categories (p<0.0002). Adjusted contrasts for race/ethnic groups with NHWs showed: ORAsian-other/NHW=1.04, 0.94-1.15; ORNHB/NHW=1.27, 1.11-1.46; and ORHispanic/NHW=1.06, 0.99-1.14. Contrasts of lower SES-categories with highest revealed an uninterupted inverse dose gradient (Trend p<0.0001). Marital status contrasts of single (S); separated, divorced, or widowed (SDW); and unknown with married (M) were: ORS/M=1.27, 1.18-1.38; ORSDW/M=1.97, 1.81-2.14; and ORUnknown/M=0.84, 0.71-1.01.

DISCUSSION: Lower ratios of delayed-stage versuss early-stage CACX during reproductive years, with increased odds for age 50+ is consistent with better screening before menopause. Absence of differences in odds of delayed-stage versus early-stage CACX among Asian/other and Hispanic women versus NHWs suggests similar screening in these race/ethnic groups, while a higher odds of delayed-stage versus early-stage CACX among NHB women persists after adjustment. An inverse dose-gradient for delayed-stage versus early-stage CACX with progressively higher SES was evident, with markedly higher odds of delayed-stage versus early-stage among SDW versusmarried women.

CONCLUSIONS: Lower SES-categories showed an inverse dose-gradient for delayed-stage versus early-stage CACX that was more robust than race-ethnicity, while SDW versus married was the strongest predictor of delayed-stage CACX.

Learning Areas:

Epidemiology
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
Differentiate independent demographic predictors of delayed-stage cervical cancer in California. Formulate strategies using demographic characteristics that improve early detection of cervical cancer.

Keyword(s): Surveillance, Evidence-Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a Professor at Loma Linda University School of Public Health, Epidemiologist for the SEER Cancer Registry of Greater California, Epidemiologist for the California Cancer Registry and co-author and mentor for this research
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4032.0: Cancer Epidemiology and Disparity