Neighborhood socioeconomic status and endometrial cancer mortality: Racial disparities persist across the spectrum

Black women are more likely to die from endometrial cancer (EC) than White women, with staggering racial disparities that have worsened with rising disease incidence and mortality. Our study examined the impact of neighborhood socioeconomic status (nSES) on EC mortality among non-Hispanic Black (NHB) and non-Hispanic White (NHW) U.S. women to better understand this stark mortality gap.

The U.S. Surveillance, Epidemiology, and End Results (SEER)-22 cancer registries database was queried for all NHW and NHB women diagnosed with malignant EC between 2006 and 2020. Age- and multivariable-adjusted Cox regression was used to evaluate the association between quintiles of census tract-level nSES and EC mortality.

In multivariable-adjusted models, NHW women in the lowest nSES quintile had higher EC mortality than their NHW counterparts in the highest nSES quintile (HR: 1.43, 95 % CI: 1.36-1.50). The association was largely attenuated for NHB patients in the lowest and highest nSES quintiles (HR: 1.08, 95 % CI: 0.99-1.17). In common referent models, NHB patients in the highest SES neighborhoods had similar mortality (HR: 1.45, 95 % CI: 1.34-1.57) to NHW patients in the lowest SES neighborhoods (HR: 1.34, 95 % CI: 1.28-1.41).

Our findings indicate that higher neighborhood SES is protective for White but not Black patients with EC. These data suggest that relative affluence is not enough to overcome other factors contributing to the worse EC survival experienced by Black women in the US. Our study demonstrates this phenomenon for the first time among US women diagnosed with EC using national-level data.