Date of Conferral

2021

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Richard C. Palmer

Abstract

Endometrial cancer is the most common gynecologic cancer in the United States with recent trends showing a continued increase in incidence and mortality. Prognosis is influenced by cancer stage at diagnosis and differs by race/ethnicity. Researchers have documented poorer survival among Blacks than Whites diagnosed with endometrial cancer. The 5-year survival rates for women with endometrial cancer is 81%; while survival for White and Black women are 84% and 62%, respectively. There is a gap in literature examining the widening disparity in incidence and survival of women diagnosed with advanced stage disease among population subgroups across the United States. The purpose of this study was to ascertain the factors associated with endometrial cancer survival disparities in the United States. The social ecological model was utilized as a conceptual framework to guide this study. Using epidemiologic data obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results [SEER] database, the cross-sectional study included 115,997 women diagnosed with endometrial cancer between 2007 and 2016. Variables associated with the outcomes of interest were assessed using multilevel logistic regression and multilevel Cox-proportional hazards models. Multivariable analyses showed that race/ethnicity, increased age, aggressive histology, poor tumor grade, and advanced-stage disease were associated with increased risk of endometrial cancer mortality. This research provides insights into the contributing factors associated with disparities in endometrial cancer survival and can lead to positive social change by developing health programs and policies that improve the survival outcomes of women who have been diagnosed with late-stage endometrial cancer.

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