Context. Racial/ethnic disparities in cancer outcomes are major public health concerns. Ovarian cancer is the tenth most common cancer and the fifth leading cause of cancer-related deaths among women. Identifying individual- and contextual-level factors contributing to racial/ethnic disparities in ovarian cancer stage of diagnosis, surgery treatment and survival is necessary for reducing and eliminating these disparities.
Objective. The study aims to examine racial/ethnic disparities in ovarian cancer diagnosis, surgery treatment and survival outcomes; to explore individual- and contextual-level factors contributing to these disparities, and to examine the trend of ovarian cancer racial/ethnic disparities from 2001 to 2012.
Methods. The study was based on the Surveillance, Epidemiology, and End Results data. Multilevel binary logistic regressions were used for the analysis of racial/ethnic disparities in late stage diagnosis and receipt of surgery adjusted for both individual- and county-level factors, respectively. Multilevel Cox-proportional hazards models were applied to analyze the racial/ethnic disparities in ovarian cancer-cause specific mortality. Joinpoint regression models were used to analyze the trend of ovarian cancer racial/ethnic disparities over time.
Result. Adjusting for age at diagnosis, marital status, tumor pathological characterstics, metro/nonmetro residence, county SES and county of residence, compared to Non-Hispanic white (NHW) patients, non-Hispanic black (NHB) patients have significantly higher probability of advanced stage diagnosis (75.44% vs. 69.52%; p=0.001), but this difference is only significant for patients living in counties of which the employment rate ranked in the first quartile. NHW patients (83.40%, 95%CI: 83.04% - 83.76%) have the highest adjusted probability of receiving surgery treatment followed by Hispanic patients (81.96%, 95%CI: 81.16% - 82.76%) and NHB patients (77.65%, 95%CI: 76.73% - 78.58%) had the lowest adjusted probability (p’s
Conclusion. The associations between individual- and contextual-level factors and ovarian cancer outcomes vary by racial/ethnic groups and should be examined separately. Multilevel culturally tailored efforts are required to decrease racial/ethnic disparities in ovarian cancer.
","abstract_html":"<p><em>Context.</em> Racial/ethnic disparities in cancer outcomes are major public health concerns. Ovarian cancer is the tenth most common cancer and the fifth leading cause of cancer-related deaths among women. Identifying individual- and contextual-level factors contributing to racial/ethnic disparities in ovarian cancer stage of diagnosis, surgery treatment and survival is necessary for reducing and eliminating these disparities.</p> <p><em>Objective</em>. The study aims to examine racial/ethnic disparities in ovarian cancer diagnosis, surgery treatment and survival outcomes; to explore individual- and contextual-level factors contributing to these disparities, and to examine the trend of ovarian cancer racial/ethnic disparities from 2001 to 2012.</p> <p><em>Methods. </em>The study was based on the Surveillance, Epidemiology, and End Results data. Multilevel binary logistic regressions were used for the analysis of racial/ethnic disparities in late stage diagnosis and receipt of surgery adjusted for both individual- and county-level factors, respectively. Multilevel Cox-proportional hazards models were applied to analyze the racial/ethnic disparities in ovarian cancer-cause specific mortality. Joinpoint regression models were used to analyze the trend of ovarian cancer racial/ethnic disparities over time.</p> <p><em> Result. </em>Adjusting for age at diagnosis, marital status, tumor pathological characterstics, metro/nonmetro residence, county SES and county of residence, compared to Non-Hispanic white (NHW) patients, non-Hispanic black (NHB) patients have significantly higher probability of advanced stage diagnosis (75.44% vs. 69.52%; p=0.001), but this difference is only significant for patients living in counties of which the employment rate ranked in the first quartile. NHW patients (83.40%, 95%CI: 83.04% - 83.76%) have the highest adjusted probability of receiving surgery treatment followed by Hispanic patients (81.96%, 95%CI: 81.16% - 82.76%) and NHB patients (77.65%, 95%CI: 76.73% - 78.58%) had the lowest adjusted probability (p’s</p> <p><em> Conclusion. </em>The associations between individual- and contextual-level factors and ovarian cancer outcomes vary by racial/ethnic groups and should be examined separately. Multilevel culturally tailored efforts are required to decrease racial/ethnic disparities in ovarian cancer.</p>","abstract_has_math":false,"creators":["Chen, Chen"],"institution":null,"degree_name":"Doctor of Public Health in Public Health Leadership (Dr.P.H.)","degree_level":"Dissertation (open access)","degree_discipline":"Jiann-Ping Hsu College of Public Health","degree_department":null,"school":null,"contributors":["Gerald Ledlow","Lili Yu","Talar Markossian"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2015,"date_issued":"2015-01-01T08:00:00Z","date_published":"2015-01-01T08:00:00Z","updated_at":"2026-07-24T02:28:22Z","subjects":["Ovarian cancer","Diagnosis","Surgery","Survival","Racial/ethnic disparities","multi-level","Epidemiology","Women's Health"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digitalcommons.georgiasouthern.edu/etd/1324","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Gerald Ledlow","Lili Yu","Talar Markossian"]},{"key":"dc:creator","label":"Author","values":["Chen, Chen"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2015-07-06T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Jiann-Ping Hsu College of Public Health"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation (open access)"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Public Health in Public Health Leadership (Dr.P.H.)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Ovarian cancer","Diagnosis","Surgery","Survival","Racial/ethnic disparities","multi-level","Epidemiology","Women's Health"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://digitalcommons.georgiasouthern.edu/etd/1324"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Context. Racial/ethnic disparities in cancer outcomes are major public health concerns. Ovarian cancer is the tenth most common cancer and the fifth leading cause of cancer-related deaths among women. Identifying individual- and contextual-level factors contributing to racial/ethnic disparities in ovarian cancer stage of diagnosis, surgery treatment and survival is necessary for reducing and eliminating these disparities.
Objective. The study aims to examine racial/ethnic disparities in ovarian cancer diagnosis, surgery treatment and survival outcomes; to explore individual- and contextual-level factors contributing to these disparities, and to examine the trend of ovarian cancer racial/ethnic disparities from 2001 to 2012.
Methods. The study was based on the Surveillance, Epidemiology, and End Results data. Multilevel binary logistic regressions were used for the analysis of racial/ethnic disparities in late stage diagnosis and receipt of surgery adjusted for both individual- and county-level factors, respectively. Multilevel Cox-proportional hazards models were applied to analyze the racial/ethnic disparities in ovarian cancer-cause specific mortality. Joinpoint regression models were used to analyze the trend of ovarian cancer racial/ethnic disparities over time.
Result. Adjusting for age at diagnosis, marital status, tumor pathological characterstics, metro/nonmetro residence, county SES and county of residence, compared to Non-Hispanic white (NHW) patients, non-Hispanic black (NHB) patients have significantly higher probability of advanced stage diagnosis (75.44% vs. 69.52%; p=0.001), but this difference is only significant for patients living in counties of which the employment rate ranked in the first quartile. NHW patients (83.40%, 95%CI: 83.04% - 83.76%) have the highest adjusted probability of receiving surgery treatment followed by Hispanic patients (81.96%, 95%CI: 81.16% - 82.76%) and NHB patients (77.65%, 95%CI: 76.73% - 78.58%) had the lowest adjusted probability (p’s
Conclusion. The associations between individual- and contextual-level factors and ovarian cancer outcomes vary by racial/ethnic groups and should be examined separately. Multilevel culturally tailored efforts are required to decrease racial/ethnic disparities in ovarian cancer.
"]},{"key":"dc:title","label":"Title","values":["Examination of Racial/Ethnic Disparities in Ovarian Cancer Stage of Diagnosis, Surgery Treatment and Survival: Multilevel Analysis of 2001-2012 SEER Data"]}]}],"canonical_facts":{"dc:contributor":["Gerald Ledlow","Lili Yu","Talar Markossian"],"dc:creator":["Chen, Chen"],"dc:date.available":["2015-07-06T07:00:00Z"],"dc:description.abstract":["Context. Racial/ethnic disparities in cancer outcomes are major public health concerns. Ovarian cancer is the tenth most common cancer and the fifth leading cause of cancer-related deaths among women. Identifying individual- and contextual-level factors contributing to racial/ethnic disparities in ovarian cancer stage of diagnosis, surgery treatment and survival is necessary for reducing and eliminating these disparities.
Objective. The study aims to examine racial/ethnic disparities in ovarian cancer diagnosis, surgery treatment and survival outcomes; to explore individual- and contextual-level factors contributing to these disparities, and to examine the trend of ovarian cancer racial/ethnic disparities from 2001 to 2012.
Methods. The study was based on the Surveillance, Epidemiology, and End Results data. Multilevel binary logistic regressions were used for the analysis of racial/ethnic disparities in late stage diagnosis and receipt of surgery adjusted for both individual- and county-level factors, respectively. Multilevel Cox-proportional hazards models were applied to analyze the racial/ethnic disparities in ovarian cancer-cause specific mortality. Joinpoint regression models were used to analyze the trend of ovarian cancer racial/ethnic disparities over time.
Result. Adjusting for age at diagnosis, marital status, tumor pathological characterstics, metro/nonmetro residence, county SES and county of residence, compared to Non-Hispanic white (NHW) patients, non-Hispanic black (NHB) patients have significantly higher probability of advanced stage diagnosis (75.44% vs. 69.52%; p=0.001), but this difference is only significant for patients living in counties of which the employment rate ranked in the first quartile. NHW patients (83.40%, 95%CI: 83.04% - 83.76%) have the highest adjusted probability of receiving surgery treatment followed by Hispanic patients (81.96%, 95%CI: 81.16% - 82.76%) and NHB patients (77.65%, 95%CI: 76.73% - 78.58%) had the lowest adjusted probability (p’s
Conclusion. The associations between individual- and contextual-level factors and ovarian cancer outcomes vary by racial/ethnic groups and should be examined separately. Multilevel culturally tailored efforts are required to decrease racial/ethnic disparities in ovarian cancer.
"],"dc:identifier":["https://digitalcommons.georgiasouthern.edu/etd/1324"],"dc:subject":["Ovarian cancer","Diagnosis","Surgery","Survival","Racial/ethnic disparities","multi-level","Epidemiology","Women's Health"],"dc:title":["Examination of Racial/Ethnic Disparities in Ovarian Cancer Stage of Diagnosis, Surgery Treatment and Survival: Multilevel Analysis of 2001-2012 SEER Data"],"thesis:degree_discipline":["Jiann-Ping Hsu College of Public Health"],"thesis:degree_level":["Dissertation (open access)"],"thesis:degree_name":["Doctor of Public Health in Public Health Leadership (Dr.P.H.)"]},"updated_at":"2026-07-24T02:28:22Z"}