Neighborhood Socioeconomic Deprivation and Perceived Discrimination Among Endometrial Cancer Survivors

Neighborhood deprivation, reflecting structural and socioeconomic disadvantage, is associated with survivors' psychosocial experiences, including discrimination. We examined associations between neighborhood deprivation and perceived discrimination among endometrial cancer survivors.

We used cross-sectional data from the Carolina Endometrial Cancer Study enrollment survey. Neighborhood deprivation was measured using the Area Deprivation Index (ADI), a composite of 17 census block group indicators of poverty, education, housing, and employment, categorized into quintiles from affluent (Q1) to vulnerable (Q5). Perceived discrimination was assessed using the 9-item Everyday Discrimination Scale. Modified Poisson and linear regression models estimate associations with past-year discrimination (yes/no) and mean discrimination scores, adjusting for age at diagnosis and geographic region.

Among 901 survivors (34% Black; mean age 61.0 years), nearly half reported discrimination in the past year. The prevalence of perceived discrimination differed by race (41% White; 58% Black). Neighborhood context differed by race, as 66% of White survivors resided in affluent neighborhoods (Q1-Q3), whereas 54% of Black survivors resided in vulnerable neighborhoods (Q4-Q5). ADI was modestly associated with discrimination overall. However, among Black survivors, residence in more deprived neighborhoods was associated with lower prevalence of past-year discrimination (aPR = 0.71; 95% CI: 0.53, 0.95) and had lower discrimination scores (0.39 points; 95% CI: 0.04, 0.74) compared with residence in affluent neighborhoods.

Neighborhood context is associated with psychosocial experiences of discrimination in racially patterned ways among endometrial cancer survivors. Our findings highlight the relevance of structural and neighborhood-level factors for describing psychosocial experiences during survivorship and persistent racial disparities.