A cohort study finds that histologic subtype is the main factor associated with survival disparities between Black and White uterine cancer patients.
Survival disparities have existed between non-Hispanic Black and White uterine cancer patients for decades, with an increased likelihood of aggressive disease, recurrence, and death among Black patients.
A cohort study published in JAMA Network Open examined the factors associated with survival disparities between Black and White patients with stage I to IV uterine cancer.
Study Population
Clinical data from 274,838 (White: 242,608, Black: 32,230) uterine cancer patients was acquired from the Commission on Cancer Accreditation. The mean age at diagnosis was 63.5 years in White patients and 63.8 years in Black patients. The median follow-up period was 74 months.
Racial Disparities in Uterine Cancer Survival Highlighted
Before balancing, Black patients demonstrated significantly worse survival than White patients (5-year survival: 58.6% vs. 78.5%, respectively). Black patients had a 2.11-fold higher unadjusted risk of death than White patients.
Racial Survival Disparity Is Driven by Histologic Subtype
The explanatory factors were incrementally balanced, and the change in excess relative risk (ERR) was determined. The hazard ratio (HR) for Black vs. White patients after balancing for age, Census division, and year of diagnosis at baseline was 2.03 and decreased to 2.01, 1.93, 1.86, 1.30, 1.22, and 1.18 after balancing for comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, and treatment, respectively.
Of the total ERR of death for Black relative to White patients, these factors accounted for 82.3%. The association with ERR individually was 54.1% due to histologic subtype, 8.3% due to disease stage, 8.2% due to neighborhood income, 6.3% due to insurance status, 3.5% due to treatment, 1.9% due to comorbidity score, and 17.7% due to unexplained factors.
Factors Influencing Racial Disparity in Cancer Survival
Of the Black patients, 17,415 received the diagnosis at younger than 65 years of age, while 14,815 received the diagnosis at 65 years of age or older. Of the White patients, 136,391 received the diagnosis at younger than 65 years of age, while 106,207 received the diagnosis at 65 years of age or older. Among patients who received the diagnosis at younger than 65 years of age, the HR for death for Black versus White patients was 2.43 in the baseline model and 1.29 after balancing other factors.
The histologic subtype, insurance status, neighborhood income, disease stage, treatment, comorbidity score, and unexplained factors accounted for 53.1%, 11.5%, 7.2%, 5.8%, 1.2%, 0.8%, and 20.4%, respectively, of the ERR among the younger Black vs. White patients. Among those who received the diagnosis at 65 years of age or older, the HR for death for Black versus White patients was 1.87 in the baseline model and 1.14 after balancing.
The histologic subtype, disease stage, neighborhood income, treatment, comorbidity score, insurance status, and unexplained factors accounted for 56.2%, 10.6%, 7.5%, 6.9%, 3.0%, 0.0%, and 15.8%, respectively, of the ERR among the Black vs. White patients 65 years of age or older. Insurance status was associated with 11.5% of the racial disparity in survival for patients younger than 65 and was not associated with racial differences in the older Medicare-eligible patients.
Source:
Kucera, C., Tian, C., Tarney, C. M., Presti, C., Jokajtys, S., Winkler, S. S., Casablanca, Y., Bateman, N. W., Mhawech‐Fauceglia, P., Wenzel, L., Hamilton, C. A., Chan, J. K., Jones, N., Rocconi, R. P., O’Connor, T. D., Farley, J., Shriver, C. D., Conrads, T. P., Phippen, N. T., . . . Darcy, K. M. (2023). Factors associated with survival disparities between Non-Hispanic Black and White patients with uterine cancer. JAMA Network Open, 6(4), e238437. https://doi.org/10.1001/jamanetworkopen.2023.8437
