Cervical cancer sociodemographic and diagnostic disparities in Florida: a population-based study (1981-2013) by stage at presentation

Objective:Florida has one of the highest cervical cancer mortality rates and socioeconomically diverse populations in the United States. We used statewide population-based cancer registry data to assess disparities in cervical cancer stage at diagnosis. Design:Primary invasive adult female cervical cancer patients in the Florida Cancer Data Registry (1981-2013) were linked with 2000 United States Census data. Early (localized) and advanced (regional and distant) stage at diagnosis was assessed by age, race, ethnicity, neighborhood socioeconomic-, marital-, and smoking- status. Univariate and multivariable logistic regression models were fit to identify factors associated with the risk of advanced cervical cancer stage at diagnosis. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated. Results:Of 18,279 women (mean(age)51.3 years old), most were non-Hispanic (83.5%), white (79.1%), middle-low neighborhood socioeconomic status (NSES) (34.7%), married (46.0%), and never smoked (56.0%). Higher odds of advanced stage was observed for blacks (aOR: 1.42, 95%CI: 1.30-1.55,p < 0.001) compared to whites, Hispanics (1.15, 1.06-1.25,p = 0.001) compared to non-Hispanics, and middle-low (1.13, 1.02-1.25,p = 0.02) and low NSES (1.42, 1.28-1.57,p < 0.001) compared to high NSES. Previously (1.30, 1.21-1.39,p < 0.001) and never married (1.37, 1.27-1.48,p < 0.001) had higher odds of presenting with advanced stage versus married women. Never smokers had decreased odds of presenting with advanced stage compared to women with history of (1.41, 1.32-1.52,p < 0.001) or current (1.29, 1.18-1.42,p <0.001)smoking status. Conclusions:There are cancer disparities in women of black race, Hispanic ethnicity and of middle-low and lowest NSES in Florida. Evidence-based interventions targeting these vulnerable groups are needed.