Racial disparities in ovarian cancer surgical care: a population-based analysis

Gynecol Oncol. 2011 May 1;121(2):364-8. doi: 10.1016/j.ygyno.2010.12.347. Epub 2011 Feb 1.

Abstract

Objective: To investigate differences according to racial classification in the frequency of ovarian cancer-related surgical procedures and in access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer.

Methods: The Maryland Health Services Cost Review Commission database was accessed for women age >18years undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 7/1/01 and 6/30/09. Multivariate logistic regression analyses were used to evaluate for differences in the likelihood of selected surgical procedures and access to high-volume surgical providers (surgeons≥10 cases/year; hospitals≥20 case/year) according racial classification.

Results: A total of 2487 patients were identified who underwent a primary surgical procedure that included oophorectomy for a malignant ovarian neoplasm: White=1884 (75.4%), African-American=400 (16.1%), and other/unknown=203 (8.2%). Compared to White patients, African-American patients were significantly younger (mean age 55.4years vs 59.9years, P<0.0001) and less likely to have commercial insurance (28.5% vs 39.5%, p<0.0001). Compared to White patients, African-American racial classification was associated with a statistically significant and independent lower likelihood of hysterectomy (OR=0.53, 95%CI=0.42-0.66, p<0.0001), colon resection (OR=0.65, 95%CI=0.48-0.87, p=0.004), lymphadenectomy (OR=0.67, 95%CI=0.50-0.91, p=0.01), and surgery by a high-volume surgeon (OR=0.55, 95%CI=0.44-0.69, p<0.0001).

Conclusions: Among women undergoing initial surgery for ovarian cancer, African-American patients are significantly less likely to be operated on by a high-volume surgeon and to undergo important ovarian cancer-specific surgical procedures compared to White patients.

MeSH terms

  • African Americans / statistics & numerical data*
  • Cross-Sectional Studies
  • Female
  • Gynecologic Surgical Procedures / statistics & numerical data
  • Healthcare Disparities*
  • Humans
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • Ovarian Neoplasms / ethnology*
  • Ovarian Neoplasms / surgery*