Table 2.
Generalized additive models (GAM) of the effect of geographic location on ovarian cancer mortality; GAM-1 unadjusted for adherence to NCCN guidelines and treating hospital ovarian cancer case volume; GAM-2 adjusted for adherence to NCCN guidelines and treating hospital ovarian cancer case volume.
| GAM-1 | GAM-2 | |||
|---|---|---|---|---|
| Characteristic | HR | 95%CI | HR | 95%CI |
| Age at diagnosis | 1.02 | 1.02–1.03 | 1.02 | 1.02–1.03 |
| Race/ethnicity | ||||
| White | 1.00 | 1.00 | ||
| Black | 1.20 | 1.06–1.36 | 1.18 | 1.04–1.34 |
| Asian/Pacific Islander | 0.93 | 0.85–1.02 | 0.93 | 0.85–1.01 |
| Hispanic | 0.92 | 0.86–0.99 | 0.92 | 0.85–1.01 |
| Socioeconomic status | ||||
| Lowest (SES-1) | 1.25 | 1.14–1.38 | 1.23 | 1.11–1.35 |
| Low-middle (SES-2) | 1.19 | 1.10–1.30 | 1.18 | 1.08–1.28 |
| Middle (SES–3) | 1.16 | 1.07–1.25 | 1.13 | 1.05–1.22 |
| High-middle (SES-4) | 1.09 | 1.02–1.17 | 1.08 | 1.00–1.16 |
| Highest (SES-5) | 1.00 | 1.00 | ||
| Insurance status | ||||
| Managed care | 1.00 | 1.00 | ||
| Medicare | 1.00 | 0.94–1.07 | 0.99 | 0.93–1.06 |
| Medicaid | 1.05 | 0.95–1.15 | 1.05 | 0.95–1.14 |
| Other | 0.96 | 0.88–1.19 | 0.94 | 0.86–1.02 |
| Uninsured | 1.03 | 0.89–1.19 | 1.05 | 0.91–1.22 |
| Unknown | 1.06 | 0.91–1.24 | 1.07 | 0.91–1.25 |
| Tumor stage | ||||
| Stage IIIC | 1.00 | 1.00 | ||
| Stage IV | 1.54 | 1.46–1.62 | 1.52 | 1.44 |
| Tumor grade | ||||
| Grade 1 | 0.61 | 0.53–0.69 | 0.59 | 0.52–0.67 |
| Grade 2 | 0.91 | 0.84–0.98 | 0.89 | 0.82–0.96 |
| Grade 3 | 1.00 | 1.00 | ||
| Grade 4 | 1.04 | 0.95–1.12 | 1.05 | 0.96–1.14 |
| Unknown | 1.33 | 1.25–1.42 | 1.28 | 1.20–1.37 |
| Tumor histology | ||||
| Serous | 1.00 | 1.00 | ||
| Mucinous | 1.58 | 1.38–1.82 | 1.53 | 1.33–1.76 |
| Endometrioid | 0.89 | 0.80–0.98 | 0.87 | 0.79–0.97 |
| Clear cell | 1.42 | 1.22–1.65 | 1.42 | 1.21–1.66 |
| Adenocarcinoma, NOS | 1.51 | 1.39–1.63 | 1.44 | 1.33–1.56 |
| Distance to care | ||||
| <5km/3mi | 1.00 | 1.00 | ||
| 5–9km/3–5mi | 0.91 | 0.84–0.98 | 0.91 | 0.84–0.98 |
| 10–16km/6–9mi | 0.94 | 0.87–1.02 | 0.95 | 0.88–1.03 |
| 17–31km/10–19mi | 0.87 | 0.81–0.94 | 0.89 | 0.82–0.97 |
| ≥32km/20mi | 0.86 | 0.79–0.93 | 0.92 | 0.84–1.00 |
| Distance to a HVH | ||||
| <9km/5mi | 1.00 | 1.00 | ||
| 9–17km/5–10mi | 1.02 | 0.94–1.10 | 0.98 | 0.91–1.06 |
| 18–33km/11–20mi | 1.07 | 0.99–1.16 | 1.02 | 0.94–1.03 |
| 34–79km/21–49mi | 1.00 | 0.92–1.08 | 0.94 | 0.86–1.02 |
| ≥80km/50mi | 1.13 | 1.03–1.23 | 1.03 | 0.94–1.14 |
| Adherence to NCCN guidelines | ||||
| Adherent | - | 1.00 | ||
| Non-adherent | - | - | 1.25 | 1.18–1.32 |
| Treating hospital volume | ||||
| LVH | - | 1.00 | ||
| HVH | - | - | 0.87 | 0.81–0.93 |
HR: hazard ratio; CI: confidence interval; NOS: not otherwise specified; NCCN: National Comprehensive Cancer Network; LVH: low-volume hospital; HVH: high-volume hospital