INTRODUCTION
The World Health Organization and National Cancer Institute have
identified Social Determinants of Health (SDH) as a broad constellation
of social, cultural and financial conditions that have a profound
influence on the trajectory of health and healthcare1–3. Significantly, SDH are recognized as impactful
forces across the cancer care pathway 4–6. Health
disparities have been identified both at the global and individual
levels, with an inequitable distribution of disease burden and disparate
outcomes 7–10. The international community has
recognized that these disparities need to be prioritized in national and
international cancer control programs 4,9,11.
Endometrial cancer is the most common gynecologic cancer in women in
North America 12, and ranks sixth most common among
all cancers in women worldwide 9. Unlike many cancers
extensively studied in health equity research, endometrial cancer has
few behavioral risk factors and no screening program; increased risk and
poor compliance with screening are therefore unlikely to play a role in
any associations of disease outcomes with social or cultural
marginalization. In spite of this, correlations between sociodemographic
factors and endometrial cancer presentation 13–17,
management 18–23 and prognosis13,18,24,25 have been shown in some studies.
The majority of publications evaluating the associations between social
determinants of health (SDH) and endometrial cancer outcomes originate
in the United States 13,18,20,24–27, where
socioeconomic factors often directly drive access to, and quality of
care. In Canada, Ontario’s population is in many ways comparable to the
US population 28, but its healthcare system is
publicly funded and offers universal access. Despite reduced
socioeconomic barriers to healthcare, disparities have been demonstrated
for some cancers in Ontario 8,29,30; however, no
evaluation of SDH and endometrial cancer outcomes in Canada has been
published to date.
Understanding the associations between SDH and endometrial cancer
outcomes in a universal access healthcare system could elucidate the
mechanisms of impact of these patient factors on disease trajectory, and
present opportunities for improved patient and provider education and
advocacy, distribution of resources and the promotion of health equity.
The primary objective of this study was to evaluate the association
between social determinants of health and survival among endometrial
cancer patients in Ontario, Canada.