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.