JNCI Cancer Spectr. 2022 Oct 14:pkac067. doi: 10.1093/jncics/pkac067. Online ahead of print.
ABSTRACT
BACKGROUND: Research suggests that geographic location may impact ovarian cancer (OC) outcomes. Insurance status often remains an important predictor of outcomes. The Affordable Care Act was enacted in 2010 to expand access to affordable health insurance. Our objective was to examine spatiotemporal trends in OC treatment non-adherence and disease-specific mortality in California (USA) among women diagnosed with OC.
METHODS: Newly diagnosed epithelial OC cases between 1996-2017 were identified from the California Cancer Registry. Spatiotemporal trends in adherence to treatment guidelines were examined using generalized additive models and OC-specific mortality using Cox proportional hazards additive models. Prediction grids covering California were used to display the odds ratios (ORs) and hazards ratios (HRs) of location, using the median value for the study area as the referent value. Seven overlapping 5-year time periods and two larger ones (pre- and post-2013) were assessed. Analyses were stratified according to stage (early versus advanced), and used P = 0.05 to determine statistical significance.
RESULTS: Statistically significant spatial patterns in treatment non-adherence were observed for every time period examined (P < 0.001). Odds of treatment non-adherence associated with geographic location were highest among women with early-stage OC in southern Los Angeles County during 2014-2017 (OR max : 3.89, Confidence Interval: 1.04-7.61). For women with advanced-stage OC, residing in Northern California was generally associated with lower ORs, while Southern California was associated with higher ORs, with higher odds in the latter time period (OR range 0.53-1.84 in 1996-2012 vs 0.49-2.37 in 2013-2017). Geographic location was not a significant predictor of mortality.
CONCLUSIONS: Residential location was significantly associated with treatment received in California, with spatial patterns varying over time, but not OC-specific mortality. Changes in insurance status over time were accompanied by shifts in population demographics and increased travel distances to receive care.
PMID:36238987 | DOI:10.1093/jncics/pkac067
