Survival after the diagnosis of endometrial cancer varies significantly between African-American and Caucasian women. Between 1992 and 1998, five-year survival for African-American women after endometrial cancer diagnosis was 58.9%, compared to 85.8% for Caucasian women. The disparity in survival is greatest among older women, with an absolute difference in five year survival of 10% for women under 50 compared to 30% for women 50 years of age and older. Prior studies have identified several factors that contribute to the observed racial disparity in endometrial cancer survival, including stage at diagnosis and tumor grade. However, significant differences in survival between Caucasian and African-American women persist even after adjusting for these factors. There are several reasons to believe that differences in the prevalence and characteristics of treatment may contribute to this residual survival disparity. African- Americans have been shown to be less likely to undergo definitive treatment for many different medical and surgical conditions. Characteristics of treatment (including provider characteristics, hospital characteristics and intensity of therapy) are associated with outcome for other surgical conditions, including surgery for lung, pancreatic and breast cancer. Understanding the prevalence and outcomes of differences in treatment characteristics between African-American and Caucasian women offers a potentially promising new approach to improving endometrial cancer survival among African-American women. ? ? In this application we propose to use SEER-Medicare linked data to examine the outcomes of African- American and Caucasian women diagnosed with endometrial cancer between 1991 and 1999. The primary outcome will be overall and disease-specific survival times (which may be censored) as assessed by Medicare vital statistics and SEER linkage to the National Death Index respectively. Analyses will adjust for comorbidity, socioeconomic status and tumor characteristics using information provided in the SEER-Medicare database. Provider and hospital characteristics will be determined by linkage to the AMA practitioner database and AHA annual survey respectively. ? ? Our three specific aims explore the contribution of differences in treatment to the higher mortality among African-American women diagnosed with endometrial cancer. We group differences in treatment into three categories: (1) differences in the rates of treatment; (2) differences in the extent/intensity of treatment; and (3) differences in the providers and hospitals/facilities who deliver the treatment. For each category, we will explore differences between African-American and Caucasian women, their association with outcome, and to what extent variations in treatment explain the excess mortality among African-American women. In addition, within each category, we will investigate differences related to primary surgery and adjuvant radiation therapy. ? ? ?
| Armstrong, Katrina; Randall, Thomas C; Polsky, Daniel et al. (2011) Racial differences in surgeons and hospitals for endometrial cancer treatment. Med Care 49:207-14 |
| Rosenbaum, Paul R (2004) The case-only odds ratio as a causal parameter. Biometrics 60:233-40 |
