title: The influence of comorbid conditions on racial disparities in endometrial cancer survival.
abstract: OBJECTIVE
  There are known disparities in endometrial cancer survival with black women who experience a greater risk of death compared with white women. The purpose of this investigation was to evaluate the role of comorbid conditions as modifiers of endometrial cancer survival by race.
  
  
  METHODS
  Two hundred seventy-one black women and 356 white women who had been diagnosed with endometrial cancer from 1990-2005 were identified from a large urban integrated health center. A retrospective chart review was conducted to gather information on comorbid conditions and other known demographic and clinical predictors of survival.
  
  
  RESULTS
  Black women experienced a higher hazard of death from any cause (hazard ratio [HR] 1.51; 95% confidence interval [CI], 1.22-1.87) and from endometrial cancer (HR, 2.42; 95% CI, 1.63-3.60). After adjustment for known clinical prognostic factors and comorbid conditions, the hazard of death for black women was elevated but no longer statistically significant for overall survival (HR, 1.22; 95% CI, 0.94-1.57), and the hazard of death from endometrial cancer remained significantly increased (HR, 2.27; 95% CI, 1.39-3.68). Both black and white women with a history of hypertension experienced a lower hazard of death from endometrial cancer (HR, 0.47; 95% CI, 0.23-0.98; and HR, 0.35; 95% CI, 0.19-0.67, respectively).
  
  
  CONCLUSIONS
  The higher prevalence of comorbid conditions among black women does not explain fully the racial disparities that are seen in endometrial cancer survival. The association between hypertension and a lower hazard of death from endometrial cancer is intriguing, and further investigation into the underlying mechanism is needed.
authors: Barbara Ann Karmanos Cancer Institute, Detroit, MI; Department of Oncology, Wayne State University, Detroit, MI. Electronic address: ruterbus@med.wayne.edu.
authors: Julie J
authors: JJ
authors: Ruterbusch
authors: Barbara Ann Karmanos Cancer Institute, Detroit, MI; Department of Pathology, Wayne State University, Detroit, MI.
authors: Rouba
authors: R
authors: Ali-Fehmi
authors: Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Sara H
authors: SH
authors: Olson
authors: Barbara Ann Karmanos Cancer Institute, Detroit, MI; Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI.
authors: Shawnita
authors: S
authors: Sealy-Jefferson
authors: Department of Public Health, Henry Ford Health System, Detroit, MI.
authors: Benjamin A
authors: BA
authors: Rybicki
authors: Department of Public Health, Henry Ford Health System, Detroit, MI; Department of Women's Health, Henry Ford Health System, Detroit, MI.
authors: Sharon
authors: S
authors: Hensley-Alford
authors: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI.
authors: Mohamed A
authors: MA
authors: Elshaikh
authors: Department of Pathology, Henry Ford Health System, Detroit, MI.
authors: Arthur R
authors: AR
authors: Gaba
authors: Department of Pathology, Henry Ford Health System, Detroit, MI.
authors: Daniel
authors: D
authors: Schultz
authors: Department of Women's Health, Henry Ford Health System, Detroit, MI.
authors: Adnan R
authors: AR
authors: Munkarah
authors: Barbara Ann Karmanos Cancer Institute, Detroit, MI; Department of Oncology, Wayne State University, Detroit, MI.
authors: Michele L
authors: ML
authors: Cote
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D018262:Adenocarcinoma, Clear Cell / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data*
keywords: comorbid condition; disease-specific survival; endometrial cancer; hypertension; racial disparity