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Comorbidities and endometrial cancer survival in Hispanics and non-Hispanic whites

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Abstract

Purpose

We investigated comorbidities and endometrial cancer survival by ethnicity because Hispanic whites (HWs) have worse survival than non-Hispanic whites (NHWs).

Methods

An endometrial cancer cohort (1992–2004) established with the Surveillance, Epidemiology and End Results-Medicare-linked database (n = 3,286) was followed through 2007. Endometrial cancer-specific and other cause mortality were evaluated with multivariate hazard ratios (mHRs).

Results

HWs were more likely than NHWs to have regional/distant disease (31.7 vs. 24.8 %), diabetes (31.7 vs. 11.0 %), and hypertension (49.4 vs. 37.6 %). HWs had poorer endometrial cancer-specific survival than NHWs (age-adjusted HR = 1.28; 95% CI 1.01–1.61), but not after adjustment for tumor characteristics and treatment (mHR = 1.02; 95% CI 0.81–1.29). In contrast, even after adjustment for cancer-related factors, other cause mortality in HWs was elevated (mHR = 1.27; 95% CI 1.01–1.59), but not after further adjustment for comorbid conditions (mHR = 1.07; 95% CI 0.85–1.35).

Conclusions

Comorbidities, particularly diabetes, were more common in HWs than in NHWs and impacted other cause mortality. Improving diabetes management may be an effective means of improving other cause mortality. This may be particularly true for HWs, given their particularly high prevalence of diabetes.

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References

  1. Sarcoma Uterine (2008) In: Schorge JO, Schaffer JI, Halvorson LM et al (eds) Williams gynecology. McGraw-Hill Companies, New York, pp 706–715

    Google Scholar 

  2. Cancer Endometrial (2008) In: Schorge JO, Schaffer JI, Halvorson LM et al (eds) Williams gynecology. McGraw-Hill Companies, New York, pp 687–705

    Google Scholar 

  3. Sherman ME, Devesa SS (2003) Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer 98(1):176–186

    Article  PubMed  Google Scholar 

  4. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group Study. Cancer 60:2035–2041

    Article  PubMed  CAS  Google Scholar 

  5. Cook LS, Kmet LM, Magliocco AM, Weiss NS (2006) Endometrial cancer survival among US black and white women by birth cohort. Epidemiology 17(4):469–472

    Article  PubMed  Google Scholar 

  6. Olson SH, Atoria C, Cote ML, et al. (2012) The impact of race and comorbidity on survival in endometrial cancer. Cancer Epidemiol Biomarkers Prev 00: 00–00 (in press)

    Google Scholar 

  7. Centers for Disease Control and Prevention (2004) Prevalence of diabetes among Hispanics, selected areas, 1998–2002. MMWR 53(40):941–944

    Google Scholar 

  8. Borrell LN (2006) Self-reported hypertension and race among Hispanics in the National Health Interview Survey. Ethn Dis 16(1):71–77

    PubMed  Google Scholar 

  9. Braithwaite D, Tammemagi CM, Moore DH et al (2009) Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer 124(5):1213–1219

    Article  PubMed  CAS  Google Scholar 

  10. Folsom AR, Anderson KE, Sweeney C, Jacobs DR Jr (2004) Diabetes as a risk factor for death following endometrial cancer. Gynecol Oncol 94(3):740–745

    Article  PubMed  Google Scholar 

  11. Chia VM, Newcomb PA, Trentham-Dietz A, Hampton JM (2007) Obesity, diabetes, and other factors in relation to survival after endometrial cancer diagnosis. Int J Gynecol Cancer 17(2):441–446

    Article  PubMed  CAS  Google Scholar 

  12. Steiner E, Plata K, Interthal C et al (2007) Diabetes mellitus is a multivariate independent prognostic factor in endometrial carcinoma: a clinicopathologic study on 313 patients. Eur J Gynaecol Oncol 28(2):95–97

    PubMed  CAS  Google Scholar 

  13. Kauppila A, Gronroos M, Nieminen U (1982) Clinical outcome in endometrial cancer. Obstet Gynecol 60(4):473–480

    PubMed  CAS  Google Scholar 

  14. Cook LS, Weiss NS, Doherty J, Chen C (2006) Endometrium. In: Schottenfeld Fraumeni (ed) Cancer epidemiology and prevention, 3rd edn. Oxford University Press, New York

    Google Scholar 

  15. Weiderpass E, Persson I, Adami HO, Magnusson C, Lindgren A, Baron JA (2000) Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 11(2):185–192

    Article  PubMed  CAS  Google Scholar 

  16. Lucenteforte E, Bosetti C, Talamini R et al (2007) Diabetes and endometrial cancer: effect modification by body weight, physical activity and hypertension. Br J Cancer 97(7):995–998

    Article  PubMed  CAS  Google Scholar 

  17. Friberg E, Mantzoros CS, Wolk A (2007) Diabetes and risk of endometrial cancer: a population-based prospective cohort study. Cancer Epidemiol Biomarkers Prev 16(2):276–280

    Article  PubMed  Google Scholar 

  18. http://healthservices.cancer.gov/seermedicare/. Accessed 3 Jan 2012

  19. Hankey BF, Ries LA, Edwards BK (1999) The surveillance, epidemiology, and end results program: a national resource. Cancer Epidemiol Biomarkers Prev 8(12):1117–1121

    PubMed  CAS  Google Scholar 

  20. http://www.naaccr.org/Research/DataAnalysisTools.aspx. Accessed 3 Jan 2012)

  21. Bach PB, Guadagnoli E, Schrag D, Schussler N, Warren JL (2002) Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care 40(8 Suppl): IV-25

    Google Scholar 

  22. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, Whelan S (eds) (2000) International classification of diseases for oncology, 3rd edn. World Health Organization, Geneva, Switzerland

  23. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  24. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  PubMed  CAS  Google Scholar 

  25. Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46(10):1075–1079

    Article  PubMed  CAS  Google Scholar 

  26. http://healthservices.cancer.gov/seermedicare/program/comorbidity.html. Accessed 3 Jan 2012

  27. Hebert PL, Yawn BP, McBean AM (1988) Identifying rural elderly individuals with diabetes mellitus using Medicare claims data. University of Minnesota Rural Health Research Center Working Paper

  28. International Classification of Diseases (ICD)-9-CM for Hospitals (2011) Ninth edition. American Medical Association and Elsevier Saunders, St Louis, Missouri Vol. 1, 2, and 3

  29. Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D (2007) A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Ann Epidemiol 17(8):584–590

    Article  PubMed  Google Scholar 

  30. Young JL (2000) SEER summary staging manual 2000: codes and coding instructions. NIH Publication No. 01-4969, Bethesda, MD

  31. Elandt-Johnson RC, Johnson NL (1980) Survival models and data analysis. Wiley, New York

    Google Scholar 

  32. Howlader N, Ries LAG, Mariotto AB et al (2010) Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst 102:1584–1598

    Article  PubMed  Google Scholar 

  33. Gold R, Michael YL, Whitlock EP et al (2006) Race/ethnicity, socioeconomic status, and lifetime morbidity burden in the women’s health initiative: a cross-sectional analysis. J Womens Health (Larchmt) 15(10):1161–1173

    Article  Google Scholar 

  34. Tucker-Seeley RD, Li Y, Sorensen G, Subramanian SV (2011) Lifecourse socioeconomic circumstances and multimorbidity among older adults. BMC Public Health 11:313

    Article  PubMed  Google Scholar 

  35. Lawlor DA, Davey SG, Patel R, Ebrahim S (2005) Life-course socioeconomic position, area deprivation, and coronary heart disease: findings from the British Women’s Heart and Health Study. Am J Public Health 95(1):91–97

    Article  PubMed  Google Scholar 

  36. Diaz-Montes TP, Alberg A, Zahurak ML, Trimble EL, Bristow RE (2005) Cancer of the uterine corpus among Hispanic women living in the United States: patterns of staging, diagnosis, and primary treatment. Gynecol Oncol 96(3):753–759

    Article  PubMed  Google Scholar 

  37. Trimble EL, Harlan LC, Clegg LX, Stevens JL (2005) Pre-operative imaging, surgery and adjuvant therapy for women diagnosed with cancer of the corpus uteri in community practice in the United States. Gynecol Oncol 96(3):741–748

    Article  PubMed  Google Scholar 

  38. Allard JE, Maxwell GL (2009) Race disparities between black and white women in the incidence, treatment, and prognosis of endometrial cancer. Cancer Control 16(1):53–56

    PubMed  Google Scholar 

  39. Clegg LX, Reichman ME, Hankey BF et al (2007) Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies. Cancer Causes Control 18(2):177–187

    Article  PubMed  Google Scholar 

  40. Crosbie EJ, Roberts C, Qian W, Swart AM, Kitchener HC, Renehan AG (2011) Body mass index does not influence post-treatment survival in early stage endometrial cancer: results from the MRC ASTEC trial. Eur J Cancer 48(6):853–864

    Article  PubMed  Google Scholar 

  41. Jeong NH, Lee JM, Lee JK et al (2010) Role of body mass index as a risk and prognostic factor of endometrioid uterine cancer in Korean women. Gynecol Oncol 118(1):24–28

    Article  PubMed  Google Scholar 

  42. Cowie CC, Rust KF, Byrd-Holt DD et al (2006) Prevalence of diabetes and impaired fasting glucose in adults in the US population: National Health and Nutrition Examination Survey 1999–2002. Diabetes Care 29(6):1263–1268

    Article  PubMed  Google Scholar 

  43. Papanas N, Giatromanolaki A, Galazios G, Maltezos E, Sivridis E (2006) Endometrial carcinoma and diabetes revisited. Eur J Gynaecol Oncol 27(5):505–508

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research was supported by grant 1R03CA143610–01 and contract HHSN261201000033C from the US National Cancer Institute, US National Institutes of Health. Additional support was provided by the University of New Mexico Cancer Research and Treatment Center, a recipient of NCI Cancer Support Grant 2 P30 CA118100-07.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Epidemiology and Biostatistics, Department of Internal Medicine and UNM Cancer Research and Treatment Center, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA

    Linda S. Cook & Charles L. Wiggins

  2. New Mexico Tumor Registry, University of New Mexico, Albuquerque, NM, USA

    Harold E. Nelson

  3. Department of Preventive Medicine and USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Myles Cockburn

  4. Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Sara H. Olson

  5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA

    Carolyn Y. Muller

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  1. Linda S. Cook
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  2. Harold E. Nelson
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  3. Myles Cockburn
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  4. Sara H. Olson
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Correspondence to Linda S. Cook.

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Cook, L.S., Nelson, H.E., Cockburn, M. et al. Comorbidities and endometrial cancer survival in Hispanics and non-Hispanic whites. Cancer Causes Control 24, 61–69 (2013). https://doi.org/10.1007/s10552-012-0090-z

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  • DOI: https://doi.org/10.1007/s10552-012-0090-z

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