Disparities in the survival of endometrial cancer patients in a public healthcare system: A population-based cohort study

Objective. Social determinants of health (SDH) have been shownto correlatewith adverse cancer outcomes. It is unclear if their impact goes beyond behavioral risk or healthcare access. We aimed to evaluate the association of SDH with endometrial cancer outcomes in a public healthcare system. Methods. A retrospective cohort study of endometrial cancer patients diagnosed between 2009 and 2017 in Ontario, Canada. Clinical and sociodemographic variables were extracted from administrative databases. Validatedmultifactorialmarginalization scores for domains of material deprivation, residential instability and ethnic concentrationwere used. Associations betweenmarginalization and survivalwere evaluated using log-rank testing and Cox proportional hazards regression. Results. 20228 women with endometrial cancer were identified. Fewer patients in marginalized communities presented with early disease (70% vs. 76%, p < 0.001) and received surgery (89% vs. 93%, p < 0.001). Overall survival was shorter amongmarginalized patients (p < 0.001). Onmultivariable analysis adjusted for patient and disease factors, overall marginalization (HR= 1.22, 95% CI 1.03-1.08), material deprivation (HR= 1.22, 95% CI 1.10-1.35) and residential instability (HR= 1.32, 95% CI 1.19-1.46) were associated with increased risk of death (p < 0.001). Conclusions. Socioeconomicmarginalization is associated with an increased risk of death in endometrial cancer patients. Targetable events in the cancer care pathway should be identified to improve health equity. Funding. This study was supported by a grant (#RD-196) from the Hamilton Health Sciences Juravinski Hospital and Cancer Center Foundation.