title: The impact of race and comorbidity on survival in endometrial cancer.
abstract: BACKGROUND
  Poorer survival from endometrial cancer in blacks than in whites is well documented. The aims of this study were to determine whether diabetes, hypertension, or other conditions influence survival and whether accounting for these conditions reduces this racial disparity.
  
  
  METHODS
  Using the SEER-Medicare database, we investigated the influence of diabetes, hypertension, and other comorbid conditions on survival in black and white women age ≥66 with endometrial cancer. We used Cox proportional hazards regression to evaluate the influence of comorbidities on survival for blacks and whites separately and to study survival differences between blacks and whites after adjustment for diabetes, hypertension, and other medical conditions, as well as for demographics, tumor characteristics, and treatment.
  
  
  RESULTS
  In both racial subgroups, women with diabetes or other conditions had poorer overall survival, whereas hypertensive black women experienced better survival [HR, 0.74; 95% confidence interval (CI), 0.60-0.92]. For disease-specific survival, diabetes was associated with poorer survival in white women (HR, 1.19; 95% CI, 1.06-1.35) but not in blacks (HR, 0.97; 95% CI, 0.73-1.30); hypertension and other conditions were not significantly related to survival. After adjustment, black women had poorer survival than white women, with HRs of 1.16 (95% CI, 1.05-1.28) for overall and 1.27 (95% CI, 1.08-1.49) for disease-specific survival.
  
  
  CONCLUSIONS
  Diabetes influences disease-specific survival in white women but not in blacks. The racial disparity in survival is not explained by the presence of other health conditions.
  
  
  CONCLUSIONS
  Further research should focus on the unknown factors that lead to poorer survival in black women compared with whites.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. olsons@mskcc.org
authors.forename: Sara H
authors.initials: SH
authors.lastname: Olson
authors.forename: Coral L
authors.initials: CL
authors.lastname: Atoria
authors.forename: Michele L
authors.initials: ML
authors.lastname: Cote
authors.forename: Linda S
authors.initials: LS
authors.lastname: Cook
authors.forename: Radhai
authors.initials: R
authors.lastname: Rastogi
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Carol L
authors.initials: CL
authors.lastname: Brown
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016016:Proportional Hazards Models; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American