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Five-Year Relative Survival Rates of Women Diagnosed with Uterine Cancer by County-Level Socioeconomic Status Overall and across Histology and Race/Ethnicity

Akemi T Wijayabahu,Jennifer K. McGee-Avila,M.S. Shiels,A. Harsono,Rebecca C Arend,Megan A Clarke

Published 2024 in Cancers

ABSTRACT

Simple Summary Persistent survival disparities by racial/ethnic groups are expected to worsen with rising incidence rates of aggressive uterine cancer subtypes. Understanding the impact of area-based socioeconomic factors on survival outcomes may help to better understand these disparities. This research aims to understand how living in counties with lower educational attainment, higher poverty, higher unemployment, lower median household income, and population density in urban areas may impact survival rates of women diagnosed with uterine cancer across racial/ethnic groups. Our findings show that lower county-level socioeconomic characteristics are linked with worse survival rates, mainly impacting women diagnosed with aggressive histologic subtypes and underrepresented racial/ethnic groups. Regardless of tumor and socioeconomic characteristics, non-Hispanic (NH) Black women consistently experience the poorest survival outcomes compared to other racial/ethnic groups included in this study. Racial/ethnic disparities in survival were observed even in the most affluent counties, suggesting that other factors beyond county-level socioeconomic status are at play. Abstract Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology across race/ethnicity. We included 333,013 women aged ≥ 30 years with microscopically confirmed uterine cancers (2000–2018) from the Surveillance, Epidemiology, and End Results 22 database followed through 2019. Age-standardized five-year relative survival rates were compared within race/ethnicity and histology, examining the differences across tertiles of county-level percent (%) <high-school education, %<150 percent poverty, %unemployment, median household income, and %urbanicity. Overall age-adjusted five-year relative survival was 77.7%. Rates were lowest among those residing in the least advantaged counties (tertile 3) and highest among the most advantaged (tertile 1): education (74.7% vs. 80.2%), poverty (72.9% vs. 79.8%), unemployment (75.7% vs. 80.5%), and income (73.3% tertile 1 vs. 78.1% tertile 3). Impact of county-level socioeconomic characteristics on survival across histology was minimal. We observed considerable survival disparities among NH-Black and NH-Native American/Alaskan Native women, regardless of tumor and socioeconomic characteristics. These findings add to our understanding of how county-level socioeconomic characteristics affect uterine cancer survival inequalities among racial/ethnic groups.

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