Impact of socio-economic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis

Abstract

Objective: To assess the impact of socio-economic deprivation on endometrial cancer survival.

Design: Single-centre prospective database study.

Setting: North West England.

Population: Women with endometrial cancer treated between 2010 and 2015.

Methods: Areal-level socio-economic status, using the English indices of multiple deprivation from residential postcodes, was analysed in relation to survival using Kaplan-Meier estimation and multivariable Cox regression.

Main outcome measures: Overall survival, cancer-specific survival and patterns and rates of recurrence.

Results: A total of 539 women, with a median age of 66 years (interquartile range, IQR 56-73 years) and a body mass index (BMI) of 32 kg/m² (IQR 26-39 kg/m² ), were included in the analysis. Women in the most deprived social group were younger (median 64 years, IQR 55-72 years) and more obese (median 34 kg/m² , IQR 28-42 kg/m² ) than women in the least deprived group (median age 68 years, IQR 60-74 years; BMI 29 kg/m² , IQR 25-36 kg/m² ; P = 0.002 and <0.001, respectively). There were no differences in endometrial cancer type, stage or grade between social groups. There was no difference in recurrence rates, however, women in the middle and most deprived social groups were more likely to present with distant/metastatic recurrence (80.6 and 79.2%, respectively) than women in the least deprived group (43.5%, P < 0.001). Women in the middle and most deprived groups had a two-fold (adjusted hazard ratio, HR = 2.00, 95% CI 1.07-3.73, P = 0.030) and 53% (adjusted HR = 1.53, 95% CI 0.77-3.04, P = 0.221) increase in cancer-specific mortality compared with women in the least deprived group. There were no differences in overall survival.

Conclusions: We found that socio-economically deprived women with endometrial cancer were more likely to develop fatal recurrence. Larger studies are needed to confirm these findings and to identify modifiable contributing factors.

Tweetable abstract: Socio-economic deprivation is linked to an increased risk of death from endometrial cancer in the North West of England.

Keywords: Endometrial cancer; prognosis; recurrence; socio-economic deprivation; survival.