Spatio-Temporal Analysis of Ovarian Cancer Mortality in California
Year: 2019
Type: article
Study design: Observational Study
Abstract: TPS 701: Spatial determinants of population health, Exhibition Hall, Ground floor, August 27, 2019, 3:00 PM - 4:30 PM Background: Some evidence suggests spatially-varying environmental exposures may contribute to ovarian cancer (OC) mortality. Geographic location has been associated with OC survival among women diagnosed in advanced-stages, yet little is known about its effect in early stages or over time. Our objective was to examine spatio-temporal trends in OC survival in California (USA) among women diagnosed in all stages. Methods: We identified women through the California Cancer Registry who were diagnosed with epithelial OC between 1996 and 2014, with follow-up through 2016. Spatio-temporal trends were examined using cox proportional hazards additive models, smoothing for residential location in six time periods that overlapped by 2 years, stratified by stage (early vs. late). All analyses were adjusted for age, socioeconomic status, insurance status, type of treatment, comorbidities, and cancer characteristics such as grade and histology. Additionally, we considered geographic access to care by including the distance traveled to receive treatment and proximity to the closest high quality-of-care hospital. Results: During the nearly 20-year period examined, 9,734 early and 20,110 late-stage OC cases were diagnosed in California. The median survival time was 34.5 months. Geographic location was significantly associated with survival among women diagnosed in advanced-stages for each time period; however, after we adjusted for covariates, location only remained an independent predictor between 2002-2006 (global p-value: 0.005). Regions of increased risk during that time were observed in the San Francisco Bay area, southern San Diego County and southern Los Angeles County. Residing in northern Los Angeles and western San Bernardino Counties was significantly protective. Conclusions: The extent to which women’s residential location impacted survival varied throughout California. Although no significant spatial patterns were observed for women in early stages, significant geographic variations existed during one time period for those diagnosed in advanced-stages. Future research should examine potential environmental impacts during that time period.
Source: Environmental Epidemiology
Institution: University of California, Irvine
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,200
OpenAlex ID: W2982239140