Year of Publication

2022

College

Public Health

Date Available

4-26-2024

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Thomas C. Tucker

Committee Member

Dr. Jaclyn McDowell

Committee Member

Dr. Steven Browning

Abstract

Objectives: Cancer of the endometrium is the most common female reproductive cancer in the United States, but is understudied in relation to stage at diagnosis, which is a potential predictor of survival. The primary objective of this study is to analyze potential associations of independent variables such as age at diagnosis, race, marital status, smoking status, Appalachian status, and insurance type with late-stage diagnosis of endometrial cancer.

Methods: This population-based study used Kentucky Cancer Registry data to study endometrial cancer cases diagnosed between January 1st,2015 and December 31st, 2019. Chi-square statistics were used to examine bivariate associations between key variables and stage-at-diagnosis. Logistic regression models were used to identify the association between independent variables and stage at diagnosis. The study followed a case-control study design and utilized population-level data. The independent variables included age at diagnosis, race, marital status, smoked tobacco use, insurance type, and Appalachian or non-Appalachian residence status. The TNM best stage variable served as the dependent variable for logistic analysis.

Results: The study included 2,658 women diagnosed with endometrial cancer from 2015-2019 in Kentucky.Significant associations were identified between women with early and late-stage disease for race, marital status, and smoked tobacco use in the bivariate model. Bivariate analyses showed significant differences among early and late-stage groups for race (p=0.004), marital status (p=0.003), age (p

Conclusions: Black women and single women in Kentucky have increased odds of late-stage diagnosis for endometrial cancer. Women who had Medicare exhibited a 30.3% decreased likelihood of diagnosis with late-stage disease compared to other non-Medicaid/Medicare insurance. Bivariate analyses showed statistically significant differences in age. Understanding potential predictors of late-stage diagnosis for endometrial cancer could drive further public health intervention aimed at increasing survival. Additionally, understanding predictors of late-stage endometrial cancer is clinically relevant. If clinicians are aware of predictors of late-stage disease, they may be more vigilant in the diagnosis of endometrial cancer in the absence of an effective screening method.

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