Mediation of Ethnic Disparity in the 5-Year Mortality of Cervical Cancer Patients in the US, 2001–2019

TL;DR

This study finds that delayed diagnosis and lack of surgery contribute to higher mortality in Black cervical cancer patients compared to White patients in the US.

Contribution

The study identifies clinical stage and surgery as key mediators of ethnic disparities in cervical cancer mortality.

Findings

Black patients had a 49% higher risk of 5-year mortality compared to White patients.

Clinical stage and surgery mediated 29.6-34.2% of the mortality disparity between Black and White patients.

Black patients with adenocarcinoma had worse outcomes, while Hispanic and Asian patients with squamous cell carcinoma had better outcomes.

Abstract

Objectives: This study aims to investigate the potential mediators for ethnic disparity in cervical cancer 5-year mortality and identify potential patients affected by ethnic disparities. Methods: The cohort study analyzed 56,374 cervical cancer patients from the Surveillance, Epidemiology, and End Results (SEER) 17 database (2000–2019). The primary and secondary outcome were the 5-year mortality of cervical cancer patients for all causes and cervical cancer-specific death, respectively. Cox and competing risks models were applied to identifying prognostic factors for 5-year cervical cancer all-cause mortality and specific death, respectively. Potential mediators for ethnic disparity were analyzed using multiple mediation analyses. Results: NHB patients had a 49% higher risk of 5-year mortality than NHW patients, while Hispanic and API patients showed a 19% and 12% decreased risk, respectively. Mediation analyses revealed that clinical stage and surgery predominately contributed to NHW-NHB prognosis disparities, with an indirect effect proportion of 29.6% and 26.7% for all-cause mortality and 34.2% and 26.7% for disease-specific death, respectively. No significant mediation effect was observed for other ethnic disparities. Compared to NHW patients, the inferior prognosis of NHB patients was observed mainly for localized and regional cancer, receiving hysterectomy, and, especially, adenocarcinomas. Conversely, the superior prognosis of Hispanic and API patients was observed in the no surgery subgroup and mainly for squamous cell carcinomas. Conclusions: Delayed diagnosis and a lack of surgery are key contributors to the prognosis discrepancy between NHB and NHW patients. More attention should be paid to NHB patients with cervical adenocarcinoma to narrow the disparity.

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