Racial disparities in survival among women with endometrial cancer in an equal access system

Amie B. Park, Kathleen M. Darcy, Chunqiao Tian, Yovanni Casablanca, Jill K. Schinkel, Lindsey Enewold, Katherine A. McGlynn, Craig D. Shriver, Kangmin Zhu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: The mortality rate for Black women with endometrial cancer (EC) is double that of White women, although the incidence rate is lower among Black women. Unequal access to care may contribute to this racial disparity. This study aimed to assess whether survival varied between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with EC in the Military Health System (MHS) which provides equal access care to its beneficiaries despite racial/ethnic background. Methods: The study was conducted using data from the U.S. Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Study subjects included NHB and NHW women with histologically confirmed and surgically managed EC diagnosed between 1988 and 2013. The study outcome was all-cause death. Overall survival between NHB and NHW women was compared using multivariable Cox modeling. Results: The study included 144 NHB and 1439 NHW women with EC. Kaplan-Meier curves showed NHB women had worse survival than NHW women (log-rank P < 0.0001). The disparity in survival between NHB and NHW women persisted after adjusting for age, diagnosis period, tumor stage, tumor histology/grade, and adjuvant treatment (HR = 1.64, 95% CI = 1.19 to 2.27). Multivariable analyses stratified by tumor features or treatment showed that the racial disparity was confined to women with low-risk features (stage I/II disease or low-grade EC) or no adjuvant treatment. Conclusion: There were racial differences in overall survival between NHB and NHW women with EC in the MHS equal access healthcare system, suggesting that factors other than access to care may be related to this racial disparity.

Original languageEnglish
Pages (from-to)125-129
Number of pages5
JournalGynecologic Oncology
Issue number1
StatePublished - Oct 2021
Externally publishedYes


  • Access to care
  • Disparity
  • Endometrial cancer
  • Race
  • Survival


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