ABSTRACT (word count: 237)
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
Tweetable abstract: Even in a public healthcare system with few
barriers to care, socioeconomic marginalization is linked with an
increased risk of death among endometrial cancer patients.