Perceived Discrimination and Healthcare System Trust as Barriers to Survivorship Care in Endometrial Cancer

Perceived discrimination can undermine healthcare system trust and contribute to medical mistrust, creating barriers to effective survivorship care. Endometrial cancer survivors, who experience intersecting social, reproductive, and aging-related challenges, remain understudied, and population-level evidence on the relationship between discrimination and medical mistrust in this group is limited.

We analyzed enrollment survey data from the population-based Carolina Endometrial Cancer Study. Perceived discrimination was measured using the 9-item Everyday Discrimination Scale, categorized into tertiles (low, moderate, high). Medical mistrust was assessed using the 7-item Medical Mistrust Index (MMI), dichotomized as ≥ 1 item endorsed. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), adjusting for age at diagnosis, region, education, and caregiving support. Analyses were conducted overall and stratified by race, education, and geography, with sensitivity analyses of frequency- and chronicity-based discrimination measures.

Among 907 survivors (35% Black, mean age 60.9 years), nearly half reported moderate or high perceived discrimination, and more than 80% endorsed ≥ 1 MMI item. Compared with low discrimination, moderate (aPR = 1.20, 95% CI: 1.12-1.30) and high discrimination (aPR = 1.26, 95% CI: 1.17-1.34) were associated with a higher prevalence of mistrust. Associations were consistent across racial, educational, and geographic subgroups. Sensitivity analyses confirmed that both the frequency and intensity of discrimination were positively associated with mistrust.

Perceived discrimination was common and strongly associated with mistrust among endometrial cancer survivors. Our findings highlight the need for culturally responsive survivorship care and equity-focused interventions to strengthen trust and engagement.