A comparison of neighborhood socioeconomic deprivation measures and the association with survival among Black and White women with endometrial cancer

Abstract

Background: Black women with endometrial cancer have twice the mortality compared with White. Survival disparities remain after accounting for individual-level socioeconomic and cancer-related factors. We investigated associations between area-based deprivation and survival and explored whether area-based deprivation attenuates the association between race and survival, among a cohort of Black and White women. Methods: Data from endometrial cancers diagnosed between 2013 and 2022 were collected from a comprehensive cancer registry covering Metropolitan Detroit. Addresses at diagnosis were linked to the area deprivation (ADI) and social vulnerability (SVI) indices. Adjusted Fine and Gray models and Cox proportional hazard models were run investigating associations between area-based deprivation measures and survival; analyses were conducted estimating the proportion of the association between race and survival that was attenuated by area-based measures. Results: Higher deprivation was associated with poorer survival, adjusted for race, insurance status, and tumor characteristics. Compared with the least disadvantaged quartile, the quartile with the highest disadvantage using ADI and SVI had 1.18 [95% confidence interval (CI), 0.99-1.43] and 1.40 (1.14-1.71) times the hazard of endometrial cancer-specific mortality, respectively. ADI and SVI attenuated 18% (3%-38%) and 27% (10%-48%) of associations between race and mortality overall and 24% (95% CI, 3%-61%) and 40% (95% CI, 16%-78%) among those with high-grade histology. Conclusions: This study demonstrates a clear association between neighborhood-level disadvantage and survival among women with endometrial cancer living in Metropolitan Detroit. Neighborhood disadvantage attenuates the relationship between race and survival, particularly among those with high-grade histology. Impact: These findings serve as motivation to understand how neighborhood affects cancer outcomes.