Term of Award

Summer 2015

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Yelena Tarasenko

Committee Member 1

Gerald Ledlow

Committee Member 2

Lili Yu

Committee Member 3

Talar Markossian

Committee Member 3 Email



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.