Influence of residential segregation and health provider density on advanced stage endometrial cancer diagnoses

Abstract

Introduction

The influence of residential segregation and provider density on endometrial (EC) presentation is not fully known. Our objective was to determine associations between county-level obstetrics-gynecology provider density and residential segregation as measured by the Index of Concentration (ICE) at the Extremes on late-stage EC diagnoses in Florida.

Methods

All malignant EC cases were identified from 2001 to 2017 in the Florida Cancer Data System (FCDS). Using 5-year estimates from the 2013–2017 American Community Survey, five county-level ICE variables were calculated: economic (high vs low), race and/or ethnicity (non-Hispanic white [NHW] vs. non)-Hispanic Black [NHB] and NHW vs. Hispanic), and racialized economic segregation (low-income NHB vs. high-income NHW and low-income Hispanic vs. high-income NHW). County-level provider density was calculated. Multivariable-adjusted logistic regression models were specified to estimate the associations.

Results

There were 44,678 EC cases with stage information. More NHB women (27.1 %) were diagnosed with aggressive EC histologies relative to NHW (16.4 %) and Hispanic women (15.5 %) (p < 0.001). NHB and Hispanic women had significantly greater odds of being diagnosed with later-stage EC compared to NHW women, regardless of residential segregation (OR: 1.46, 95 % CI: 1.36, 1.56 and OR: 1.09, 95 % CI: 1.01, 1.17, respectively). Women living in the most economically disadvantaged Hispanic segregated counties had greater odds of being diagnosed with later-stage EC compared to those living in more NHW segregated areas (OR: 1.16, 95 % CI: 1.00, 1.35). Provider density was not associated with later-stage diagnosis.

Conclusion

Advanced stage EC at diagnosis seems to be largely independent of provider density and residential segregation.