RACIAL-DIFFERENCES IN SURVIVAL FROM GYNECOLOGIC CANCER

Objective: To determine whether survival from gynecologic cancer is di fferent between African-American and white patients at an inner-city h ospital with both a large clinic and a private service. Methods: We st udied 538 patients (89 African American, 449 white) diagnosed with cer vical, uterine, or ovarian cancer at a single institution from January 1, 1989 through December 31, 1993. information was obtained on age, s tage, site of disease, histology, and type of health insurance (public or commercial). Insurance coverage was used as a proxy for socioecono mic status. Overall survival was estimated by the method of Kaplan and Meier and compared by the log-rank test. Cox proportional hazard mode ling was used to evaluate the effects of multiple factors on survival. Results: African-American patients were significantly older and were more likely to have cervical cancer and public insurance than white pa tients. Overall survival was worse for African-American patients than for white patients (P<.05). However, stage for stage, there was no sig nificant difference in survival between the groups. There was also no difference when patients were grouped by insurance status. African Ame ricans had a significantly worse survival for cervical cancer than whi tes, and African-American patients older than 65 years had a worse sur vival than whites of similar age. On multivariate analysis, only stage and insurance coverage were significant predictors of survival. Concl usions: African-American patients with gynecologic cancer at our insti tution have worse overall survival than white patients. The survival d ifference seems to be due predominantly to differences in socioeconomi c status and stage at diagnosis. Copyright (C) 1996 by The American Co llege of Obstetricians and Gynecologists.