Date of Conferral

9-4-2026

Date of Award

September 2026

Degree

Ph.D.

School

Health Sciences

Advisor

Leah Miller

Abstract

Endometrial cancer is the fourth most common gynecologic malignancy in the United States, with a rising incidence among postmenopausal women. Although geographic disparities in cancer outcomes have been documented nationally, survival differences by urban versus rural residence and receipt of surgery remain understudied in Idaho. The purpose of this quantitative, retrospective cohort study was to examine the associations of urban versus rural residence, and receipt of surgery with 5-year survival among women in Idaho, a largely rural and underserved state. Guided by the social-ecological model and social determinants of health, this study used secondary data from the National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) database. Inclusion criteria were women aged 45–85 years and older, diagnosed with primary endometrial cancer between 2000 –2021 who had complete survival and covariate data. The final sample included 1,284 women. Binary logistic regression estimated the odds of 5-year survival by residence and surgery status after adjusting for covariates. Rural versus urban residence was not significantly associated with 5-year survival after adjustment for the covariates. Women who underwent surgery had four times higher odds of surviving at least 5 years than women who did not (OR = 0.25, 95% CI [0.106, 0.591], p = .002)), whereas older age at diagnosis was associated with lower odds of survival (p = .01). This study supports positive social change by informing health agencies, policymakers, and cancer programs in Idaho about rural/urban and treatment-related disparities in endometrial cancer survival. These findings can help guide efforts to improve access to timely diagnosis, surgery, and follow-up care for women with endometrial cancer.

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