Reducing Endometrial Cancer Disparities to Advance Health Equity (REACH Study) ID 2683434

INTRODUCTION: Racial disparities in endometrial cancer survival have been increasing over the past 10 years. While Black women are diagnosed more often with aggressive histologic subtypes, studies have found tumor characteristics only partially account for their lower rates of survival. The degree to which system factors such as insurance and access to subspecialty care contribute to disparate survival outcomes is unclear. METHODS: This was a retrospective cohort study of individuals diagnosed with endometrial cancer from 2005 to 2021 within a large integrated health care system with high levels of access to gynecologic oncologists. Data were extracted from tumor registry and electronic databases. Multivariable logistic regression was used to evaluate associations between 1- and 5-year survival rates and race. RESULTS: Among 11,249 women, 61.9% identified as White, 15.1% Asian, 7.8% Black, 13.6% Hispanic, and 0.6% mixed or unknown race, with 46.5% having public insurance through Medicare or Medi-Cal. In preliminary analysis, Black women had lower survival compared to White women at 1 year (87.4% versus 92.3%) and 5 years (67% versus 78.7%) (OR 0.57; 95% CI, 0.46–0.71; P <.001). However, when adjusted for histology and stage, survival differences between Black and White women at both 1 year (OR 0.83; 95% CI, 0.65–1.07; P =.15) and 5 years (OR 0.92; 95% CI, 0.73–1.15; P =.45) were no longer significant. CONCLUSION: Among a diverse group of insured individuals receiving care within an integrated health care system, tumor characteristics largely accounted for racial disparities in survival. These findings suggest that disparities in survival not explained by tumor characteristics can be addressed by closing gaps in insurance coverage and access to care.