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- Title
Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer.
- Authors
Kucera, Calen W.; Tian, Chunqiao; Tarney, Christopher M.; Presti, Cassandra; Jokajtys, Suzanne; Winkler, Stuart S.; Casablanca, Yovanni; Bateman, Nicholas W.; Mhawech-Fauceglia, Paulette; Wenzel, Lari; Hamilton, Chad A.; Chan, John K.; Jones, Nathaniel L.; Rocconi, Rodney P.; O'Connor, Timothy D.; Farley, John H.; Shriver, Craig D.; Conrads, Thomas P.; Phippen, Neil T.; Maxwell, G. Larry
- Abstract
Key Points: Question: What factors are most associated with racial disparities in survival between non-Hispanic Black and non-Hispanic White patients with uterine cancer? Findings: In this cohort study of 274 838 patients from the National Cancer Database, histologic subtype was associated with 54% of the racial disparities in survival. Insurance status was the major modifiable factor among those who received a diagnosis of uterine cancer at an age younger than 65 years. Meaning: This study suggests that histologic subtype was the dominant factor associated with racial disparities in survival among Black and White patients with uterine cancer. Importance: Disparities in survival exist between non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) patients with uterine cancer. Objective: To investigate factors associated with racial disparities in survival between Black and White patients with uterine cancer. Design, Setting, and Patients: This cohort study used data from the National Cancer Database on 274 838 Black and White patients who received a diagnosis of uterine cancer from January 1, 2004, to December 31, 2017, with follow-up through December 2020. Statistical analysis was performed in July 2022. Main Outcomes and Measures: Overall survival by self-reported race and evaluation of explanatory study factors associated with hazard ratio (HR) reduction for Black vs White patients. A propensity scoring approach was applied sequentially to balance racial differences in demographic characteristics, comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, and treatment. Results: The study included 32 230 Black female patients (mean [SD] age at diagnosis, 63.8 [10.0] years) and 242 608 White female patients (mean [SD] age at diagnosis, 63.5 [10.5] years) and had a median follow-up of 74.0 months (range, 43.5-113.8 months). Black patients were more likely than White patients to have low income (44.1% vs 14.0%), be uninsured (5.7% vs 2.6%), present with nonendometrioid histologic characteristics (46.1% vs 21.6%), have an advanced disease stage (34.1% vs 19.8%), receive first-line chemotherapy (33.8% vs 18.2%), and have worse 5-year survival (58.6% vs 78.5%). Among patients who received a diagnosis at younger than 65 years of age, the HR for death for Black vs White patients was 2.43 (95% CI, 2.34-2.52) in a baseline demographic-adjusted model and 1.29 (95% CI, 1.23-1.35) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 0.8%, 7.2%, 11.5%, 53.1%, 5.8%, 1.2%, and 20.4%, respectively, of the excess relative risk (ERR) among the younger Black vs White patients. Among patients 65 years or older, the HR for death for Black vs White patients was 1.87 (95% CI, 1.81-1.93) in the baseline model and 1.14 (95% CI, 1.09-1.19) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 3.0%, 7.5%, 0.0%, 56.2%, 10.6%, 6.9%, and 15.8%, respectively, of the ERR among Black vs White patients aged 65 years or older. Conclusions and Relevance: This study suggests that histologic subtype was the dominant factor associated with racial survival disparity among patients with uterine cancer, while insurance status represented the main modifiable factor for women younger than 65 years. Additional studies of interactions between biology and social determinants of health are merited. This cohort study uses data from the National Cancer Database to investigate factors associated with racial disparities in survival between Black and White patients with uterine cancer.
- Subjects
CONFIDENCE intervals; UTERINE tumors; BLACK people; RACE; INCOME; SEVERITY of illness index; T-test (Statistics); SURVIVAL analysis (Biometry); DESCRIPTIVE statistics; CHI-squared test; KAPLAN-Meier estimator; RESEARCH funding; WHITE people; HEALTH equity; LOGISTIC regression analysis; DATA analysis software; LONGITUDINAL method; PROBABILITY theory; COMORBIDITY; INSURANCE
- Publication
JAMA Network Open, 2023, Vol 6, Issue 4, pe238437
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.8437