Country-of-birth disparities in high-grade endometrial cancer: A European-first population-based analysis on incidence, age at presentation, and survival in an equal-access health system in the Netherlands

Abstract

Introduction Endometrial cancer (EC) incidence and outcomes vary globally, with ethnic disparities well-studied in the United States but less documented in Europe. This study aimed to investigate disparities in incidence of high-grade EC, age at diagnosis, and survival among women diagnosed with EC in the Netherlands, stratified by country of birth. Methodology We conducted a population-based cohort study including all patients diagnosed with primary EC in the Netherlands Cancer Registry between 2010 and 2022 (n = 25 834). Patients were categorized by integrated country-of-birth groups. Descriptive statistical analysis, logistic regression (to calculate odds ratios (ORs) with confidence intervals (CIs) for high-grade EC diagnosis, adjusting for age, body mass index, and year of diagnosis) and survival analyses were performed. Results Median age of diagnosis for high-grade EC was lower for patients born outside the Netherlands compared to Dutch-born patients. Patients born in Africa (OR 2.02; CI1.54–2.64), Surinam & Dutch Caribbean (OR 2.09; CI1.76–2.48), America & Oceania (OR 1.98; CI1.32–2.94), Asia (OR 1.57; CI1.32–1.87), and Turkey (OR 1.39; CI1.04–1.86) had significantly higher baseline-adjusted risk for high-grade EC compared to Dutch-born patients. Survival analyses showed increased risk of death for patients born in Surinam & Dutch Caribbean (HR 1.39; CI1.16–1.68), Asia (HR 1.51; CI1.26–1.82), and Europe (HR 1.22; CI1.02–1.46) after adjusting for age, BMI, histology, and stage. Conclusions The significant disparities in the incidence of high-grade EC, with worse survival of EC by country of birth, underline the urgent need to further study the role of ethnicity in tailored diagnostic and treatment approach.