Racial Disparities in Endometrial Cancer Specific Survival Among Women Diagnosed in The United States from 2000 to 2021 Restricted; Files Only
McVey Moffatt, Arnetta (Spring 2025)
Abstract
Background: Despite the similarities in incidence, there are extreme racial disparities in endometrial cancer (EC) deaths, with Non-Hispanic Black (NHB) women currently being twice as likely to die from the disease as Non-Hispanic White (NHW) women. Epidemiologic research on the drivers of racial disparities in EC is still limited, and the role of social determinants of health in explaining why NHB women are more likely to develop aggressive disease and face double the mortality rate remains unclear. We will assess the tumor, treatment, and sociodemographic characteristics that drive the differences in EC-specific mortality between NHB and NHW women diagnosed with EC from 2000 to 2021 in the United States.
Methods: We identified 19,548 NHB and 136,374 NHW women diagnosed with first primary EC between 2000 and 2021 in SEER. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CIs) comparing NHB vs NHW EC-specific mortality by tumor, treatment, and sociodemographic characteristics.
Results: On average, women were followed for 7.1 years (range 0 to 22 years). We observed 4,666 EC-specific deaths among NHB women and 16,927 EC-specific deaths among NHW women. The overall age-adjusted hazard ratio was 2.46 (95% CI 2.38, 2.54) comparing the EC-specific mortality hazard between NHB and NHW women. In multivariable-adjusted models, NHB women with localized disease had an EC-specific mortality rate 1.94 times that of NHW counterparts (95% CI 1.80, 2.08). NHB women with low-grade endometrial tumors had a rate 1.59 times higher than NHW counterparts (95% CI 1.46, 1.74). Marital status conferred no survival advantage for NHB women; the greatest disparity was among married women (rate ratio 1.40; 95% CI 1.32, 1.49) with interaction on the multiplicative scale. Racial disparities among women who were single, received no surgical treatment, or were diagnosed with clear cell tumors were less pronounced.
Conclusion: In the United States, the largest racial disparities are observed in less aggressive tumors and are especially pronounced among women diagnosed with localized disease. Further research is warranted to elucidate the factors driving disparities in tumors associated with more favorable prognoses.
Table of Contents
Introduction ................................................................................................................................. 1
Methods ........................................................................................................................................ 7
Results ......................................................................................................................................... 11
Discussion .................................................................................................................................. 16
References .................................................................................................................................. 26
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