title: Disparities in endometrial cancer outcomes between non-Hispanic White and Hispanic women.
abstract: OBJECTIVE
  To compare demographics, tumor characteristics, the first course of treatment, and cancer-specific survival of non-Hispanic White and Hispanic women with endometrial cancer.
  
  
  METHODS
  We used public-use data from the Surveillance, Epidemiology, and End Results (SEER) Program. The study included 69,764 non-Hispanic White and Hispanic women diagnosed with endometrial cancer between 2000 and 2010. Using Cox proportional hazards models, demographics, tumor characteristics, and treatment were assessed as potential explanatory variables for the survival disparity between non-Hispanic Whites and Hispanics.
  
  
  RESULTS
  Kaplan-Meier estimation with Bonferroni correction showed statistically different cancer-specific survival for U.S.-born and foreign-born Hispanics compared to non-Hispanic Whites, but no difference between birthplace-unknown Hispanics and non-Hispanic Whites. In 2000-2005, U.S.-born and foreign-born Hispanics had a higher risk of endometrial cancer death compared to non-Hispanic Whites after full adjustment (hazard rate (HR)=1.61, 95% Confidence Interval (CI):1.44-1.79 and 1.27, 95% CI:1.13-1.43). In 2006-2010, the risk of endometrial death was not statistically significant for U.S.-born Hispanics (HR=1.16, 95% CI:0.99-1.36), but increased for foreign-born Hispanics (HR=1.31, 95% CI:1.12-1.52). Most of the survival disparity between Hispanic and non-Hispanic White women was mediated by cancer characteristics, specifically, stage and node involvement.
  
  
  CONCLUSIONS
  Hispanic women have higher cancer-specific mortality compared to non-Hispanic Whites. Compared to 2000-2005, more Hispanics were diagnosed at later stages and fewer received combination therapy in 2006-2010. Early detection is vital to improving endometrial cancer survival as most of the disparity was mediated by stage. Increased efforts are needed to improve education and access to care for Hispanic women.
authors.affiliation: Department of Obstetrics & Gynecology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA. Electronic address: an3rodri@utmb.edu.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Rodriguez
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. Electronic address: KSchmele@mdanderson.org.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.affiliation: Department of Preventive Medicine and Community Health, 301 University Boulevard, The University of Texas Medical Branch, Galveston, TX, USA. Electronic address: yokuo@utmb.edu.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: Endometrial cancer; Hispanics; Non-Hispanic Whites; SEER