Cervical cancer outcomes analysis: Impact of age, race, and comorbid illness on hospitalizations for invasive carcinoma of the cervix

Objective. The aim of this study was to evaluate the association of age, ra ce, and comorbid illness with procedures and complications in hospitalized patients with invasive carcinoma of the cervix in a statewide population-ba sed database over a 3-year period. Methods. Hospitalizations were classified into homogeneous subgroups based on a diagnosis of invasive cervical cancer. Cancer-related complications an d comorbid diseases were evaluated. chi(2) and t tests determined differenc es in means or proportions. Linear regression techniques were applied to bu ild models for hospitalization charges and lengths of stay (LOS). Results. There were 1009 admissions. The mean age was 49.5, with a median a ge of 46 (21-100, SD 15.4). Of the total, 606/1009 (60%) were white, 354/10 09 (35%) were African-American (AA), and 5% were "other" races. AAs were mo re likely to have Medicaid or be uninsured (44% vs 23%, P = 0.001) and were more likely to be admitted for an emergency (unadjusted odds ratio (OR) = 1.6; 1.2-2.2), to have a comorbid illness (P = 0.001), to be admitted for a cancer-related complication (P = 0.036), to be admitted for a transfusion (P = 0.01), and to be admitted for radiation therapy rather than surgery (P = 0.001). The following were associated with LOS and higher hospital costs : emergency admissions for complications of cancer, comorbid illness, and o lder age. Conclusions. Racial differences exist in patterns of admission, type of the rapy, and severity of illness; however, there were no differences in charge s or LOS for similar procedures. The large percentage of African-Americans uninsured or insured by government-supported programs indicates the potenti al impact of public policy on the care of these patients. Socioeconomic sta tus rather than phenotypic appearance may be a more important determinant o f outcome. (C) 2000 Academic Press.