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Published on: September 12, 2019
Disparities in the Diagnosis and Treatment of Endometrial Cancer Among People with Disabilities
Joon-Young Hong1, Kyungdo Han2, Hea Lim Choi3
1Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Obstetrics and Gynecology, Seoul, South Korea; Sungkyunkwan University, The Samsung Advanced Institute of Health Science & Technology (SAIHST), Department of Clinical Research Design and Evaluation, Seoul, Korea.
Objective:
To investigate differences in stage at diagnosis, treatment receipt, and mortality among patients with endometrial cancer who had or did not have registered disabilities in South Korea.
Methods:
This retrospective nationwide cohort study used data from a claims-linked cancer registry. Women aged ≥30 years who were diagnosed with endometrial cancer between 2012 and 2019 were included. Disability status was identified through the national disability registration system and categorized by type and severity. Multi-variable logistic regression, Cox proportional hazards, and Fine-Gray competing risk models were used.
Results:
A total of 18,067 women with endometrial cancer were included (median age, 56 years; inter-quartile range; 49-65); 1185 (6.6%) had a registered disability. Compared with women without disabilities, those with disabilities were more likely to be diagnosed with distant-stage disease (8.9% vs 6.1%, p < .001) or unknown stage (4.8% vs 3.4%, p < .001), and were less likely to receive chemotherapy (adjusted odds ratio 0.76, 95% confidence interval 0.64 to 0.91). Severe disability was associated with lower odds of receiving surgery (adjusted odds ratio 0.54; 95% confidence interval 0.41 to 0.71) and chemotherapy (adjusted odds ratio 0.67; 95% confidence interval 0.51 to 0.87). Disability was associated with higher overall mortality (adjusted hazard ratio 1.31; 95% confidence interval 1.15 to 1.50) and cancer-specific mortality (adjusted hazard ratio 2.03; 95% confidence interval 1.55 to 2.65), particularly among patients with severe disability and brain or other impairments.
Conclusions:
Women with disabilities experienced disparities in stage at diagnosis, treatment receipt, and survival after endometrial cancer diagnosis. These findings highlight the need for further efforts to understand and address barriers contributing to inequities in cancer care.
