ABSTRACT
OBJECTIVE: To identify racial disparities in five-year survival rates in women affected by serous epithelial ovarian carcinoma in the United States (US). METHODS: This retrospective cohort study analyzed data from the 2010 to 2016 Surveillance, Epidemiology, and End Results (SEER) program database. Women with a primary malignancy of serous epithelial ovarian carcinoma, using International Classification of Diseases for Oncology (ICD-O) Topography Coding and ICD-O-3 Histology Coding, were included in this study. Race and ethnicity were combined into the following groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic Other (NHO), and Hispanics. Cancer-specific survival was measured at five years post-diagnosis. A comparison of baseline characteristics was assessed using Chi-squared tests. Unadjusted and adjusted Cox regression models were used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS: From 2010 to 2016, there were 9,630 women with a primary diagnosis of serous ovarian carcinoma identified in the SEER database. A higher proportion of Asian/PI women (90.7%) were diagnosed with high-grade malignancy (poorly differentiated/undifferentiated) compared to NHW women (85.4%). NHB women (9.7%) were less likely to undergo surgery when compared to NHW women (6.7%). Hispanic women had the highest proportion of uninsured women (5.9%), while NHW and NHAPI had the lowest (2.2% each). A higher proportion of NHB (74.2%) and Asian/PI (71.3%) women presented with the distant disease compared to NHW women (70.2%). After adjustment for age, insurance, marital status, stage, metastases, and surgical resection, NHB women had the highest hazard of death within five years compared to NHW women (adjusted (adj) HR 1.22, 95% CI 1.09-1.36, p<0.001). Hispanic women also had lower five-year survival probabilities compared to NHW women (adj HR 1.21, 95% CI 1.12-1.30, p<0.001). Patients undergoing surgery had significantly increased survival probability compared to those who did not (p<0.001). As expected, women with Grade III and Grade IV disease both had significantly lower five-year survival probabilities compared to Grade I (p<0.001). CONCLUSION: This study reveals that there is an association between race and overall survival in patients with serous ovarian carcinoma, with NHB and Hispanic women having the highest hazards of death compared to NHW women. This adds to the existing body of literature as survival outcomes in Hispanic patients relative to NHW patients are not well documented. Because of the potential interplay between overall survival and several factors including race, future studies should aim to investigate other socioeconomic factors that may be impacting survival.
ABSTRACT
Introduction and objective While the use of electronic cigarettes (e-cigarettes) continues to gain popularity amongst consumers, literature focusing on the safety and risks of e-cigarette usage remains scarce. Literature focused on the potential effects of e-cigarette use on fetal development is particularly limited. The objective of this study is to investigate the association between the use of e-cigarettes during pregnancy and unfavorable birth outcomes. Methods A retrospective cohort using secondary data analysis was conducted from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2017 Phase 8 survey. This database contains both state-specific and population-based information on maternal attitudes and experiences before, during, and shortly after pregnancy. Female participants in the study were initially found through each state's birth certificate file. Eligible women included those who have had a recent live birth. Data collection procedures and instruments were standardized to allow comparisons between states. The independent variable was self-reported use of any e-cigarette products during pregnancy. The dependent variable was dichotomized into the presence of at least one unfavorable birth outcome (preterm birth, low birth weight, or extended postnatal hospital stay for the newborn) or the absence of all. Binary logistic regression analysis was used to calculate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI). Results A total of 71,940 women were included in our study. After adjusting for age, race, ethnicity, insurance, maternal education, prenatal care, physical abuse during pregnancy, and complications during pregnancy, the odds of unfavorable birth outcomes increase by 62% among women who reported e-cigarette use during pregnancy versus women who did not (aOR 1.62, 95%CI 1.16-2.26, p-value 0.005). Conclusions/implications Moving forward, it is imperative for consumers to understand the implications of using e-cigarettes, such as the increased risk of unfavorable birth outcomes associated with use during pregnancy. Moreover, healthcare providers, particularly obstetricians, should be encouraged to communicate this novel information to at-risk patients. Overall, researchers must continue to study the long-term effects of e-cigarettes, including those on fetal development, as there is still much to be uncovered.