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. 2025 Apr 1;8(4):e257227.
doi: 10.1001/jamanetworkopen.2025.7227.

Geographic Variation of Racial and Ethnic Differences in Uterine Cancer Survival

Caitlin E Meade  1 , Jennifer A Sinnott  2 , Tasleem J Padamsee  3 , Megan A Clarke  4 , Jesse J Plascak  5 , Casey M Cosgrove  6 , Britton Trabert  7   8 , Ashley S Felix  1
Affiliations

Geographic Variation of Racial and Ethnic Differences in Uterine Cancer Survival

Caitlin E Meade et al. JAMA Netw Open. .

Abstract

Importance: Racial and ethnic disparities in uterine cancer survival are well-documented; however, limited data exist regarding the interplay of geography, diversity, and race and ethnicity in survival disparities.

Objective: To examine associations of race and ethnicity with uterine cancer-specific survival according to geographic region and regional diversity.

Design, setting, and participants: This retrospective cohort study included patients with uterine cancer diagnosed from 2000 to 2019, from 17 Surveillance, Epidemiology, End Results registries, grouped by US location and ranked according to the US Census Bureau's Diversity Index (DI; range, 0%-100%; higher values indicate greater diversity), a metric of racial and ethnic composition. Analyses were conducted from June 8, 2024 to October 30, 2024.

Exposures: Race and ethnicity of patients with uterine cancer, categorized as Asian, Black, Hispanic, and White.

Main outcomes and measures: Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for multivariable-adjusted associations of race and ethnicity with uterine cancer-specific survival (primary outcome) in the overall sample and stratified by location. Location-stratified models were used to examine whether associations of race and ethnicity with survival varied by tumor characteristics.

Results: Among 162 500 patients with uterine cancer (median [IQR] age at diagnosis, 61 [54-69] years), there were 12 226 Asian patients (7.5%), 14 007 Black patients (8.6%), 20 799 Hispanic patients (12.8%), and 115 468 White patients (71.1%). Cancer-specific survival was better among Asian patients (HR, 0.91; 95% CI, 0.86-0.97), worse among Black patients (HR, 1.34; 95% CI, 1.28-1.40), and not different among Hispanic patients (HR, 1.01; 95% CI, 0.97-1.06) compared with White patients. Location-stratified analyses found worse uterine cancer-specific survival among Black patients compared with White patients in both higher DI locations (California: HR, 1.34; 95% CI, 1.25-1.44; DI, 69.7%; New Jersey: HR, 1.34; 95% CI, 1.21-1.50; DI, 65.8%; Georgia: HR, 1.39; 95% CI, 1.26-1.53; DI = 64.1%) and lower DI locations (Louisiana: HR, 1.34; 95% CI, 1.16-1.54; DI = 58.6%; Connecticut: HR, 1.42; 95% CI, 1.17-1.72; DI, 55.7%; Iowa: HR, 1.71; 95% CI, 1.01-2.89; DI, 30.8%). Hispanic patients, compared with White patients, had worse survival in Hawaii (HR, 2.09; 95% CI, 1.28-3.42) and Georgia (HR, 1.44; 95% CI, 1.13-1.82), whereas Asian patients had better survival than White patients in California (HR, 0.91; 95% CI, 0.84-0.97). In locations demonstrating survival disparities between Black and White patients, these patterns were evident in most tumor characteristic-defined strata.

Conclusions and relevance: In this cohort study of patients with uterine cancer, racial and ethnic disparities in survival within specific geographic areas were identified. Targeted research may reduce national disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Sinnott, Padamsee, Plascak, and Felix reported receiving grants from the National Cancer Institute during the conduct of the study. Dr Plascak reported receiving personal fees from the National Comprehensive Cancer Network. Dr Cosgrove reported receiving personal fees and research support from GSK; personal fees from AstraZeneca, Intuitive, and Merck; and grants from Regeneron outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Survival Curves Race and Ethnicity and Uterine Cancer–Specific Survival in the Overall Sample, California, New Jersey, and Georgia
Compared with White patients, Asian patients showed improved or similar survival; Black patients experienced worse uterine survival in the overall sample, California, New Jersey, and Georgia; and Hispanic patients experienced worse survival in Georgia. HR indicates hazard ratio.
Figure 2.
Figure 2.. Association of Race and Ethnicity With Uterine Cancer–Specific Survival Among Asian Patients Stratified by Histology and Stage in the Overall Sample, California, New Jersey, and Georgia
White patients are the reference group for all comparisons. Asian patients diagnosed with nonendometrioid or advanced-stage tumors had better cancer-specific survival. Within the California registry, Asian patients diagnosed with advanced-stage tumors had better cancer-specific survival. Diversity index (DI) ranged from 0% to 100%, with higher percentage indicating more diversity. HR indicates hazard ratio.
Figure 3.
Figure 3.. Association of Race and Ethnicity With Survival Among Black Patients Stratified by Histology and Stage in the Overall Sample, California, New Jersey, and Georgia
White patients are the reference group for all comparisons. Black patients had worse uterine cancer–specific survival in all histology and stage subgroups. Worse cancer-specific survival was also noted for Black patients in 1 or more tumor-defined subgroups within Georgia, California, and New Jersey. Diversity index (DI) ranged from 0% to 100%, with higher percentage indicating more diversity. HR indicates hazard ratio.
Figure 4.
Figure 4.. Association of Race and Ethnicity With Survival Among Hispanic Patients Stratified by Histology and Stage in the Overall Sample, California, New Jersey, and Georgia
White patients are the reference group for all comparisons. No significant differences were noted among Hispanic patients in the overall sample. Within the Georgia registry, Hispanic patients diagnosed with early-stage tumors had worse cancer-specific survival. Diversity index (DI) ranged from 0% to 100%, with higher percentage indicating more diversity. HR indicates hazard ratio.
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