Disparities in the survival of endometrial cancer patients in a public
healthcare system: A population-based cohort study.
Abstract
Objective: Social determinants of health (SDH) have been shown to
correlate with adverse cancer outcomes. It is unclear if their impact
goes beyond behavioral risk or healthcare access. We aimed to evaluate
the association of SDH with endometrial cancer outcomes in a public
healthcare system. Design and Setting: A retrospective cohort study of
endometrial cancer patients in Ontario, Canada. Population: Women
diagnosed with endometrial cancer in Ontario between 2009-2017. Methods:
Clinical and sociodemographic variables were extracted from
administrative databases. Validated marginalization scores for material
deprivation, residential instability and ethnic concentration were used.
Associations between marginalization and survival were evaluated using
log-rank testing and Cox proportional hazards regression. Results: 20228
women with endometrial cancer were identified. Fewer patients in
marginalized communities presented with early disease (70% vs. 76%,
p<0.001) and received surgery (89% vs. 93%,
p<0.001). Overall survival was shorter among marginalized
patients (p<0.001). On multivariable analysis adjusted for
patient and disease factors, overall marginalization (HR=1.22, 95% CI
1.03-1.08), material deprivation (HR=1.22, 95% CI 1.10-1.35) and
residential instability (HR=1.32, 95% CI 1.19-1.46) were associated
with increased risk of death (p<0.001). Conclusions:
Socioeconomic marginalization is associated with an increased risk of
death in endometrial cancer patients. Targetable events in the cancer
care pathway should be identified to improve health equity Funding: This
study was supported by a grant (#RD-196) from the Hamilton Health
Sciences Juravinski Hospital and Cancer Center Foundation Keywords:
uterine cancer, endometrial cancer, social determinants of health