title: Racial disparity in survival of patients with uterine serous carcinoma: Changes in clinical characteristics, patterns of care and outcomes over time from 1988 to 2011.
abstract: OBJECTIVE
  To determine if the disparities in the outcome between white (W) and African American (AA) patients with uterine serous carcinoma (USC) have changed over time.
  
  
  METHODS
  Women with USC were identified using the SEER database from 1988 to 2011 (N=7667). Years of the study were divided into three periods (1988-1997, 1998-2004 and 2005-2011). Overall (OS) and disease-specific survivals (DSS) was estimated.
  
  
  RESULTS
  Over the three time periods, African American patients continued to be younger and less likely to have cancer directed surgery and extensive lymphadenectomy when compared to white patients. In multivariable analysis adjusting for age, race, marital status, stage, cancer-directed surgery, extent of lymphadenectomy, adjuvant radiation, and geographic location, AA was significantly associated with worse DSS and OS in the three time periods compared to white race. African American patients were 29% (95% CI 1.03-1.62, p=0.027) in 1988-1997, 40% in 1998-2004 (95% CI 1.21-1.63, p<0.0001) and 34% in 2005-2011 (95% CI 1.13-1.59, p=0.0008) more likely to die from uterine cancer compared to their white counterparts. A slight improvement in the difference in OS over time was noted comparing African American and white patients. African American patients were 46% (95% CI 1.23-1.73, p<0.0001) in 1988-1997, 39% in 1998-2004 (95% CI 1.23-1.56, p<0.0001) and 26% in 2005-2011 (95% CI 1.10-1.45, p<0.0001) more likely to die from any cause compared to their white counterparts.
  
  
  CONCLUSIONS
  Significant improvement in outcome was noted in both racial groups over time. However, African American patients continued to have worse outcome than white patients over time.
authors.affiliation: Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: mahdih@ccf.org.
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.affiliation: Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA.
authors.forename: Xiaozhen
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Abdul-Karim
authors.affiliation: Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vargas
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D018426:SEER Program; D012923:Social Class; D013997:Time Factors; D014594:Uterine Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D044465:White People
keywords: African American; Disparity; Outcome; Race; SEER; Trends; Uterine serous carcinoma