ASPO Abstracts
Neighborhood and Individual Social Barriers to Care-Seeking for Ovarian Cancer Symptoms in African American Women
Category: Cancer Health Disparities, Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
Ovarian cancer is the most deadly gynecologic cancer, and survival is poorer among African American women. Delay in diagnosis and treatment may contribute to this disparity, but existing work has only examined financial barriers to care. We examined social barriers (mean everyday discrimination and trust in physician scores) on the individual and neighborhood level as they relate to delay in care-seeking among 548 African American women with ovarian cancer enrolled in the multisite case control African American Cancer Epidemiology Study (AACES). The outcome was defined as having above average symptom duration, at least eight months, in the year prior to diagnosis. Models were adjusted for age at diagnosis, marital status, body mass index, Charlson co-morbidity score, education, and income. Access to care variables included insurance, regular physician relationship, primary care provider density within a census tract, and self-reported barriers to accessing healthcare. Census-tract level affluence and disadvantage factors derived from neighborhood socioeconomic characteristics (% poverty, median home value, etc.) were hypothesized to be effect modifiers of discrimination. In our analysis, 41% (n=225) of women reported at least one symptom for eight months prior to diagnosis. After adjustment for confounders, a one-unit increase in frequency of mean everyday discrimination was associated with 1.89 times the odds of care seeking delay (OR 1.89 CI 1.37-2.62) for women with average neighborhood affluence and disadvantage. One standard deviation increase in neighborhood disadvantage was associated with 81% higher odds of care delay due to discrimination (OR 1.81 CI 1.10-2.98). Similarly, higher neighborhood affluence was associated with 73% higher odds of care delay due to discrimination (OR 1.73 CI 1.01-2.99). Longer symptom duration was not associated with trust in physicians or not having a physician, type of insurance coverage or lapse in insurance coverage, barriers to care, education, or income. The association of perceived discrimination and longer symptom duration among African American women with ovarian cancer suggests, at both the individual and neighborhood levels, social barriers to care are an important area for further research.
Keywords: Ovarian Cancer, discrimination, care-delay, racial disparity