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. 2014 Dec;211(6):627.e1-9.
doi: 10.1016/j.ajog.2014.06.036. Epub 2014 Jun 19.

The influence of comorbid conditions on racial disparities in endometrial cancer survival

Julie J Ruterbusch  1 , Rouba Ali-Fehmi  2 , Sara H Olson  3 , Shawnita Sealy-Jefferson  4 , Benjamin A Rybicki  5 , Sharon Hensley-Alford  6 , Mohamed A Elshaikh  7 , Arthur R Gaba  8 , Daniel Schultz  8 , Adnan R Munkarah  9 , Michele L Cote  10
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The influence of comorbid conditions on racial disparities in endometrial cancer survival

Julie J Ruterbusch et al. Am J Obstet Gynecol. 2014 Dec.

Abstract

Objective: There are known disparities in endometrial cancer survival with black women who experience a greater risk of death compared with white women. The purpose of this investigation was to evaluate the role of comorbid conditions as modifiers of endometrial cancer survival by race.

Study design: Two hundred seventy-one black women and 356 white women who had been diagnosed with endometrial cancer from 1990-2005 were identified from a large urban integrated health center. A retrospective chart review was conducted to gather information on comorbid conditions and other known demographic and clinical predictors of survival.

Results: Black women experienced a higher hazard of death from any cause (hazard ratio [HR] 1.51; 95% confidence interval [CI], 1.22-1.87) and from endometrial cancer (HR, 2.42; 95% CI, 1.63-3.60). After adjustment for known clinical prognostic factors and comorbid conditions, the hazard of death for black women was elevated but no longer statistically significant for overall survival (HR, 1.22; 95% CI, 0.94-1.57), and the hazard of death from endometrial cancer remained significantly increased (HR, 2.27; 95% CI, 1.39-3.68). Both black and white women with a history of hypertension experienced a lower hazard of death from endometrial cancer (HR, 0.47; 95% CI, 0.23-0.98; and HR, 0.35; 95% CI, 0.19-0.67, respectively).

Conclusion: The higher prevalence of comorbid conditions among black women does not explain fully the racial disparities that are seen in endometrial cancer survival. The association between hypertension and a lower hazard of death from endometrial cancer is intriguing, and further investigation into the underlying mechanism is needed.

Keywords: comorbid condition; disease-specific survival; endometrial cancer; hypertension; racial disparity.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

FIGURE
FIGURE. Endometrial cancer survival by race
A, Overall survival; B, disease-specific survival. Ruterbusch. Race, comorbidities, and endometrial cancer survival. Am J Obstet Gynecol 2014.
See this image and copyright information in PMC

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