Racial Disparities and Mortality Rates for Ovarian Cancer in Texas, 1999-2009

Background: Ovarian cancer is the leading cause of gynecological cancer-associated deaths, being the fifth most common of all cancer-associated deaths among women. Regional variation in mortality rates can be due to race and ethnicity, their distribution, varied reproductive patterns, tubal ligation, socioeconomic status, access to healthcare and diet. Other risk factors such as family history, early menarche, and late menopause, and nulliparity have also been identified. Hypothesis and Objective: The hypotheses of this study are: 1. Race is a predictor of mortality rates for ovarian cancer. 2. There is a significant difference in demographics, socioeconomic status and ovarian cancer mortality rates between 1999 and 2009 years in the counties of Texas. 3. Access to health care, age, lack of insurance, and reproductive pattern, are significant geographic variables associated with ovarian cancer mortality in Texas. The objective is to test these hypotheses. Materials and Methods: A cross-sectional study was conducted using the demographic and access to healthcare county level data obtained from the US Census Bureau 2000 and County Health Rankings and Roadmap website for the years 1999 and 2009 for women in Texas which were matched with the age-adjusted death rates (AADR) for the same periods obtained from the Texas Department of State Health Services and Texas State Data Center. Two sample t-tests were performed to evaluate the difference between the trends of 1999 and 2009. Correlation coefficient and multiple regression model analysis were performed to analyze the relationship between mortality rates and uninsured adults and between primary care provider rate (PPR) and socioeconomic status, respectively. Spatial analysis including mapping and hot spot analysis was also performed to find significant clusters. Results: Income level, education, and poverty levels improved significantly from 1999 to 2009 in white women but not in blacks. The average family size of whites (2.86) was significantly less than blacks (3.28). The PPR was negatively correlated to the mortality rates. Low median household income in past 12 months was significantly related to AADR (p-value= 0.01). Eastern Texas showed consistently high AADR from 1999 to 2009. Hot spot analysis revealed very few significant clusters in central and north Texas. Conclusion: Racial disparities and geographical factors can play an important role in predicting the disease outcome.