TY - JOUR
T1 - Impact of socioeconomic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis
AU - Njoku, Kelechi
AU - Barr, Chloe
AU - Hotchkies, Leo
AU - Quille, Nomondary
AU - Wan, Louise
AU - Crosbie, Emma
N1 - Funding Information:
Cancer Research UK (CRUK) Manchester Cancer Research Centre Clinical Research Fellowship (C147/A25254) and the National Institute of Health Research Manchester Biomedical Research Centre (IS-BRC-1215-20007). KN is supported by a Cancer Research UK (CRUK) Manchester Cancer Research Centre Clinical Research Fellowship (C147/A25254) and the Wellcome Trust Manchester Translational Informatics Training Scheme. CEB is supported by a Manchester University NHS Foundation Trust Clinical Research Fellowship. LW is supported by a National Institute for Health Research (NIHR) Academic Clinical Lectureship. EJC is supported by the NIHR Manchester Biomedical Research Centre (IS-BRC-1215-20007). We would like to thank the women whose data contributed to this study. We would also like to thank the clinical staff at St Mary?s Hospital Manchester who provide care to women with gynaecological cancers in the North West of England.
Funding Information:
KN is supported by a Cancer Research UK (CRUK) Manchester Cancer Research Centre Clinical Research Fellowship (C147/A25254) and the Wellcome Trust Manchester Translational Informatics Training Scheme. CEB is supported by a Manchester University NHS Foundation Trust Clinical Research Fellowship. LW is supported by a National Institute for Health Research (NIHR) Academic Clinical Lectureship. EJC is supported by the NIHR Manchester Biomedical Research Centre (IS‐BRC‐1215‐20007).
Publisher Copyright:
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd
PY - 2021/1/21
Y1 - 2021/1/21
N2 - 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/m
2 (IQR 26–39 kg/m
2), 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/m
2, IQR 28–42 kg/m
2) than women in the least deprived group (median age 68 years, IQR 60–74 years; BMI 29 kg/m
2, IQR 25–36 kg/m
2; 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.
AB - 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/m
2 (IQR 26–39 kg/m
2), 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/m
2, IQR 28–42 kg/m
2) than women in the least deprived group (median age 68 years, IQR 60–74 years; BMI 29 kg/m
2, IQR 25–36 kg/m
2; 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.
KW - Aged
KW - Databases, Factual
KW - Diabetes Mellitus/epidemiology
KW - Endometrial Neoplasms/mortality
KW - England/epidemiology
KW - Female
KW - Health Status Disparities
KW - Humans
KW - Middle Aged
KW - Neoplasm Metastasis
KW - Neoplasm Recurrence, Local/mortality
KW - Obesity/epidemiology
KW - Prospective Studies
KW - Social Class
KW - Socioeconomic Factors
U2 - 10.1111/1471-0528.16618
DO - 10.1111/1471-0528.16618
M3 - Article
C2 - 33289967
VL - 128
SP - 1215
EP - 1224
JO - BJOG
JF - BJOG
SN - 1470-0328
IS - 7
ER -