Uterine Cancer Survival Varies Widely by Race Across US
A study of 162,500 patients with uterine cancer found that survival rates varied significantly by race and geographic location, with Black patients experiencing the worst survival outcomes in areas with high and low overall diversity.
METHODOLOGY:
Despite known racial and ethnic disparities in uterine cancer survival in the United States, data on the association between geographic region and these disparities remain limited.
A retrospective cohort study analyzed outcomes from 162,500 patients with uterine cancer (median age, 61 years at diagnosis) between 2000 and 2019 from 17 Surveillance, Epidemiology, and End Results (SEER) registries.
Researchers categorized patients by race and ethnicity: 7.5% were Asian individuals, 8.6% were Black individuals, 12.8% were Hispanic individuals, and 71.1% were White individuals.
Geographic locations were ranked from 0% to 100% by the US Census Bureau's Diversity Index, with higher values indicating greater diversity. Values varied from 76.0% for Hawaii to 30.8% for Iowa.
The primary outcome was uterine cancer–specific survival. The median follow-up durations were 84 months for Asian patients, 59 months for Black patients, 73 months for Hispanic patients, and 93 months for White patients.
TAKEAWAY:
Compared with White patients, Asian patients had better cancer-specific survival (hazard ratio [HR], 0.91), whereas Black patients had worse cancer-specific survival (HR, 1.34), and cancer-specific survival for Hispanic patients was similar (HR, 1.01; 95% CI, 0.97-1.06 ).
Black patients experienced worse survival than White patients in both high-diversity areas (HR, 1.34 in California and New Jersey; HR, 1.39 in Georgia) and low-diversity locations (HR, 1.34 in Louisiana; HR, 1.42 in Connecticut; HR, 1.71 in Iowa).
Compared with White patients, Hispanic patients showed worse survival in Hawaii (HR, 2.09) and Georgia (HR, 1.44), whereas Asian patients demonstrated better survival in California (HR, 0.91).
Black patients with low-grade endometrioid, nonendometrioid, and early-stage disease had worse survival in Louisiana than White patients (HRs 2.08, 1.29, and 1.77, respectively), and those with high-grade endometrioid disease in Seattle and nonendometrioid disease in Iowa also had worse outcomes (HRs, 2.23 and 2.01, respectively).
IN PRACTICE:
'In this cohort study of patients with uterine cancer, racially and ethnically disparate uterine cancer–specific survival was observed in specific geographic locations,' the authors wrote. 'While etiologic studies that assess the causes of geographically defined racially and ethnically disparate uterine cancer survival are needed, our findings suggest that locations with the most pronounced racial and ethnic disparities should be prioritized.'
SOURCE:
The study, led by Caitlin E. Meade, Division of Epidemiology, College of Public Health, Ohio State University in Columbus, Ohio, was published online in JAMA Network Open .
LIMITATIONS:
The analysis focused was limited to 11 locations with SEER registries. The researchers noted that the low power in areas with lower diversity indices might have affected the detection of racial and ethnic disparities. The study also lacked other measures of structural inequities and systemic discrimination that could contextualize the findings.
DISCLOSURES:
The study received grants from the National Cancer Institute. Several authors reported receiving personal fees or grants from various sources.
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