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Description
Endometrial cancer is a common malignancy of the female reproductive system that accounts for approximately 6% of all cancers in women. Despite having a lower incidence of endometrial cancer, black women suffer from a disproportionate mortality rate almost twice as high as their white counterparts. A retrospective cohort study was conducted to evaluate the role of county socioeconomic measures (abstracted from the 1990 U.S Census) in determining survival and stage at presentation among black and white women with endometrial cancer. The study population consisted of 30,187 (94.7%) white and 1,705 (5.3%) black women registered in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. When stratified by race, statistical analysis revealed significant differences between black and white women across all clinical and county socioeconomic variables. Black study subjects had a significantly lower median survival time of 87 months compared to 118 months in white subjects. Additionally they were more likely to be diagnosed at advanced (regional and distant) stages of disease and experienced a higher frequency of Grades III and IV tumors. Compared to their white counterparts, black patients resided in undereducated, impoverished counties with a median household income ≤ $30,000/yr, and an unemployment rate ≥ 5.3%. The area-based measures: county poverty level, educational attainment, median household income, and unemployment rate were significantly associated with cause-specific survival for the entire study population. In univariate analysis, lower county socioeconomic status was associated with worse survival for both black and white women. Within socioeconomic stratum, black women were more likely to die than white women indicating that racial disparities in survival are magnified for black patients residing in counties with lower socioeconomic indices. The addition of prognostic covariates eliminated survival disparities based upon county socioeconomic measures among white women. However, within each county socioeconomic stratum, differences in adjusted mortality risk between black and white women were still evident. While county socioeconomic status is overall associated with survival, it plays a more dramatic role in predicting morality risk among black subjects. Analysis showed that the county attributes: percentage below the poverty level and percentage of unemployed persons are significantly associated with advanced stage disease. These findings suggest that contextual socioeconomic factors may play a role in tumor development and progression before diagnosis and that interventions targeted to socioeconomically disadvantaged counties may increase patient survival from endometrial cancer and influence the frequency of high risk disease.
