Racial Differences in Cervical Cancer Survival in the Detroit Metropolitan Area

Purpose African American (AA) women have lower survival rates for cervical cancer when compared with white women. The purpose of this study was to examine the influence of socioeconomic status (SES) on disparities in overall survival among women with cervical cancer. Methods 1036 women (705 white and 331 AA) with a primary invasive cancer of the cervix were identified from the 1988 to 1992 Detroit SEER database. SES proxy was determined using occupation, poverty status, and educational level at the census-block level. Women were then assigned to one of four SES groups. Chi-square statistics were used to compare demographic, clinical characteristics and treatment modalities. A multivariable Cox model and Kaplan-Meier survival curves were used to compare survival rates between the two races. Results AA women were less likely to present with less severe disease (p<0.001), with 48.9% of AA women presenting with stage 1 disease compared with 59.6% of white women. There were also differences in SES between AA and white women (p<0.001), with 73.1% of AA women residing in a census block categorized as Working Poor (WP), and 33.0% of white women residing in a census block designated as Professional (P). After adjusting for age, marital status, SES, histology, stage and treatment, race no longer had a significant effect on overall survival. Women from the WP census block had a higher risk of death than women from the P SES census block (hazard ratio: 1.30; 95% CI 1.00–1.69). Conclusions Patient age at diagnosis, stage, treatment, and SES all influence racial differences in survival among women with cervical cancer. When adjusted for these variables, AA and white women have similar overall survival rates.