The Impact of Race and Comorbidity on Survival in Endometrial Cancer

Abstract

Background: Poorer survival from endometrial cancer in blacks than in whites is well documented. The aims of this study were to determine whether diabetes, hypertension, or other conditions influence survival and whether accounting for these conditions reduces this racial disparity.Methods: Using the SEER-Medicare database, we investigated the influence of diabetes, hypertension, and other comorbid conditions on survival in black and white women age 66 with endometrial cancer. We used Cox proportional hazards regression to evaluate the influence of comorbidities on survival for blacks and whites separately and to study survival differences between blacks and whites after adjustment for diabetes, hypertension, and other medical conditions, as well as for demographics, tumor characteristics, and treatment.Results: In both racial subgroups, women with diabetes or other conditions had poorer overall survival, whereas hypertensive black women experienced better survival [HR, 0.74; 95% confidence interval (CI), 0.60-0.92]. For disease-specific survival, diabetes was associated with poorer survival in white women (HR, 1.19; 95% CI, 1.06-1.35) but not in blacks (HR, 0.97; 95% CI, 0.73-1.30); hypertension and other conditions were not significantly related to survival. After adjustment, black women had poorer survival than white women, with HRs of 1.16 (95% CI, 1.05-1.28) for overall and 1.27 (95% CI, 1.08-1.49) for disease-specific survival.Conclusions: Diabetes influences disease-specific survival in white women but not in blacks. The racial disparity in survival is not explained by the presence of other health conditions. Impact: Further research should focus on the unknown factors that lead to poorer survival in black women compared with whites. Cancer Epidemiol Biomarkers Prev; 21(5); 753-60. Ó2012 AACR.

Does Age-Adjusted Charlson Comorbidity Score Impact Survival Endpoints in Women with Federation of Gynecology and Obstetrics-Stage III Endometrial Cancer?

“…A very abbreviated and less granular comorbidity scoring systems called Klabunde et al [20] or Deyo et al [21] adaptations of the originally validated Charlson comorbidity index [13] are included as a variable in some national databases such as National Cancer Database [22] or SEER-Medicare linked data sets to study outcomes [23]. In using these abbreviated tools, subjects are assigned a score of only 0, 1, or ≥2 in contrast to the original validated score used in the current study that can reach up to 25 points [13].…”

The Growing Burden of Endometrial Cancer: A Major Racial Disparity Affecting Black Women

“…It is somewhat surprising that Hispanic women do not suffer the same excess burden from endometrial cancer, given that rates of obesity and diabetes are similar to NHB women (34). These conditions have been associated with endometrial cancer etiology and, in some studies, with survival, with potential differences by race/ ethnicity and histologic subtype, highlighting the complex underlying biologic pathways involved in carcinogenesis (35)(36)(37)(38)(39).…”

Pediatric choroid plexus tumors: epidemiology, treatments, and outcome analysis on 202 children from the SEER database

“…The SEER datasets are highly regarded as very reliable sources of demographic, treatment, and survival data for a wide variety of neoplasms, and have included benign brain tumors since 2004 [13][14][15][16][17][18]. This tumor registry contains data on more than a quarter of the US population [5], and as such allows adequately powered statistical analysis on rare tumors [6], such as CPTs.…”