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. 2023 Jun 1;32(6):818-824.
doi: 10.1158/1055-9965.EPI-23-0038.

Racial/Ethnic Disparities in Cervical Cancer Stage at Diagnosis: Mediating Effects of Neighborhood-level Socioeconomic Deprivation

Itunu O Sokale  1   2 , Abiodun O Oluyomi  1   2 , Jane R Montealegre  2   3 , Aaron P Thrift  1   2
Affiliations

Racial/Ethnic Disparities in Cervical Cancer Stage at Diagnosis: Mediating Effects of Neighborhood-level Socioeconomic Deprivation

Itunu O Sokale et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Mortality from cervical cancer has declined steadily in the United States over the past several decades due to widespread screening for precancerous and early-stage cervical cancer (ECC), which are significantly easier to treat compared with late-stage cervical cancer (LCC). Unequal screening access continues to cause significant racial/ethnic disparities in cervical cancer diagnosis stage. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and cervical cancer diagnosis stage.

Methods: We analyzed Texas Cancer Registry data for cervical cancer cases diagnosed among women ages 18 or older from 2010 to 2018. We performed causal mediation analyses of the association between race/ethnicity and cervical cancer stage at diagnosis mediated by neighborhood-level socioeconomic disadvantage.

Results: Of the 9,192 women with cervical cancer, 4,720 (51.3%) had LCC at diagnosis. Compared with non-Hispanic white (NHW) women (106.13, standard deviation (SD) = 13.32), non-Hispanic Black (NHB; 111.46, SD = 9.55) and Hispanic (112.32, SD = 9.42) women had higher area deprivation index (ADI) and had greater odds of LCC diagnosis [total effects: adjusted odds ratios (AOR) = 1.29 (95% CI, 1.11-1.46) and AOR 1.14 (95% CI, 1.03-1.25), respectively]. Approximately 34.7% and 71.6% of the disparity in LCC diagnosis were attributable to higher neighborhood socioeconomic disadvantage among NHB and Hispanic women, respectively.

Conclusions: LCC disparity varied by race/ethnicity and was partly attributable to neighborhood disadvantage. The disparity among Hispanic women due to neighborhood deprivation was twice as high among NHB women.

Impact: Findings may be used to develop targeted race- and place-specific interventions to improve cancer care equity.

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Figures

Figure 1. Mediation analysis model. The figure shows the causal mediation analysis pathways, including the total effect, direct, and indirect effects.
Figure 1.
Mediation analysis model. The figure shows the causal mediation analysis pathways, including the total effect, direct, and indirect effects.
Figure 2. Components of the counterfactual framework-based model. The figure shows components of the causal mediation model using the counterfactual framework.
Figure 2.
Components of the counterfactual framework-based model. The figure shows components of the causal mediation model using the counterfactual framework.
See this image and copyright information in PMC

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