Geographic Variation of Racial and Ethnic Differences in Uterine Cancer Survival
Authors: Caitlin E. Meade, Jennifer A. Sinnott, Tasleem J. Padamsee, Megan A. Clarke, Jesse J. Plascak, Casey M. Cosgrove, Britton Trabert, Ashley S. Felix
Journal: JAMA Network Open (2025)

Importance Racial and ethnic disparities in uterine cancer survival are well-documented; however, limited data exist regarding the interplay of geography, diversity, and race and ethnicity in survival disparities. Objective To examine associations of race and ethnicity with uterine cancer–specific survival according to geographic region and regional diversity. Design, Setting, and Participants This retrospective cohort study included patients with uterine cancer diagnosed from 2000 to 2019, from 17 Surveillance, Epidemiology, End Results registries, grouped by US location and ranked according to the US Census Bureau’s Diversity Index (DI; range, 0%-100%; higher values indicate greater diversity), a metric of racial and ethnic composition. Analyses were conducted from June 8, 2024 to October 30, 2024. Exposures Race and ethnicity of patients with uterine cancer, categorized as Asian, Black, Hispanic, and White. Main Outcomes and Measures Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for multivariable-adjusted associations of race and ethnicity with uterine cancer–specific survival (primary outcome) in the overall sample and stratified by location. Location-stratified models were used to examine whether associations of race and ethnicity with survival varied by tumor characteristics. Results Among 162 500 patients with uterine cancer (median [IQR] age at diagnosis, 61 [54-69] years), there were 12 226 Asian patients (7.5%), 14 007 Black patients (8.6%), 20 799 Hispanic patients (12.8%), and 115 468 White patients (71.1%). Cancer-specific survival was better among Asian patients (HR, 0.91; 95% CI, 0.86-0.97), worse among Black patients (HR, 1.34; 95% CI, 1.28-1.40), and not different among Hispanic patients (HR, 1.01; 95% CI, 0.97-1.06) compared with White patients. Location-stratified analyses found worse uterine cancer–specific survival among Black patients compared with White patients in both higher DI locations (California: HR, 1.34; 95% CI, 1.25-1.44; DI, 69.7%; New Jersey: HR, 1.34; 95% CI, 1.21-1.50; DI, 65.8%; Georgia: HR, 1.39; 95% CI, 1.26-1.53; DI = 64.1%) and lower DI locations (Louisiana: HR, 1.34; 95% CI, 1.16-1.54; DI = 58.6%; Connecticut: HR, 1.42; 95% CI, 1.17-1.72; DI, 55.7%; Iowa: HR, 1.71; 95% CI, 1.01-2.89; DI, 30.8%). Hispanic patients, compared with White patients, had worse survival in Hawaii (HR, 2.09; 95% CI, 1.28-3.42) and Georgia (HR, 1.44; 95% CI, 1.13-1.82), whereas Asian patients had better survival than White patients in California (HR, 0.91; 95% CI, 0.84-0.97). In locations demonstrating survival disparities between Black and White patients, these patterns were evident in most tumor characteristic–defined strata. Conclusions and Relevance In this cohort study of patients with uterine cancer, racial and ethnic disparities in survival within specific geographic areas were identified. Targeted research may reduce national disparities.