Abstract / Summary
OBJECTIVE: To assess the associations of time to treatment initiation and overall survival with race and ethnicity by socioeconomic status (SES) among women with advanced endometrial cancer. We also aimed to evaluate the role of social and clinical determinants in time to treatment initiation and overall survival. METHODS: We conducted a retrospective cohort study using the Flatiron Health Research Database among adult women diagnosed with advanced (stages III–IV) endometrial cancer or who developed recurrence between 2013 and 2022. The main outcomes included delayed treatment initiation (more than 6 weeks) and all-cause mortality. Primary exposures included race and ethnicity and quintiles of area-level SES (Yost Index). We computed adjusted prevalence ratios with 95% CIs using multivariable modified Poisson regressions to assess racial and ethnic disparities in time to treatment initiation, and we computed adjusted hazard ratios (HRs) using Cox proportional hazards models to assess disparities in mortality. All models were adjusted for sociodemographic factors, comorbidities, and cancer and histology characteristics. RESULTS: Among the 4,177 women included in this study, the racial and ethnic composition included 68.1% non-Hispanic White, 15.2% non-Hispanic Black, 5.3% Hispanic/Latina, and 2.2% non-Hispanic Asian. The median time to treatment initiation was 26 days, and the median survival time was 3.1 years. After adjustments for participant characteristics, delayed treatment initiation was associated with living in areas of the lowest SES quintile among non-Hispanic Black (adjusted prevalence ratio 1.07, 95% CI, 1.00–1.13) and Hispanic/Latina (adjusted prevalence ratio 1.12, 95% CI, 1.00–1.25) participants compared with non-Hispanic White participants. We observed an inverted moderating effect on all-cause mortality in which non-Hispanic Black participants living in areas of the highest SES quintile had a higher risk of death compared with non-Hispanic White participants (adjusted HR 2.49, 95% CI, 1.55–4.00). CONCLUSION: Our findings demonstrated that racial and ethnic disparities in treatment initiation and survival persist among women with advanced endometrial cancer and are significantly modified by socioeconomic factors.