Perceived discrimination, trust in physicians, and their associations with ovarian cancer mortality among women in the African American Cancer Epidemiology Study

Abstract

Purpose: Black women are 30% more likely to die of ovarian cancer than White women. Discrimination may affect cancer health disparities through pathways including socioeconomic disadvantage, chronic stress, and access to care. In this study, we evaluated associations of discrimination and trust in physicians with all-cause mortality among Black women with ovarian cancer. Methods: Using data from the African American Cancer Epidemiology Study (AACES), we included 592 Black ovarian cancer patients who completed an interview. Discrimination and trust in physicians were measured using the Everyday Discrimination, Major Experiences of Discrimination, and Trust in Physicians scales, respectively. We used Cox proportional hazard models to compute multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) associating everyday discrimination, major experiences of discrimination, and trust in physicians with all-cause mortality. Results: Approximately 43% reported experiencing at least one major experience of discrimination, 16% reported high everyday experiences of discrimination, and the median trust in physician score was 35. The association between higher experiences of everyday discrimination was HR = 0.84 (95% CI: 0.63, 1.11), compared with low experiences of everyday discrimination. We observed that more major experiences of discrimination had 1.25-times the mortality rate compared with low experiences of major discrimination (95% CI: 0.84, 2.20). Higher trust in physicians was associated with slightly lower mortality rates (HR = 0.91, 95% CI: 0.74, 1.14). Conclusion: We observed complexities in the relationships of everyday discrimination, major experiences of discrimination, and trust in physicians with mortality among Black women with ovarian cancer. Future work to understand the these relationships is likely warranted.