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

Background: 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.

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