Risk factors for endometrial cancer incidence and regional and ethnic disparities in the USA.
7 affiliations
- 1Center for Interdisciplinary Research in Women's Health, School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA.
- 2Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA.
- 3Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, Texas, USA.
- 4School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA.
- 5Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas, USA.
- 6Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA.
- 7Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery, The University of Warwick, Coventry, UK.
Abstract
Background
Endometrial cancer (EC) is the most common gynaecologic cancer in the USA and a major cause of cancer-associated mortality among women. We aimed to identify the independent contributions of individual- and contextual-level factors to EC incidence.Methods
We conducted a longitudinal retrospective cohort study using anonymised data from women aged 18 years and above without EC included in the All of Us Research database before 1 January 2017. We followed participants from study entry until October 2023 (median follow-up = 6.6 years). We used mixed-effects Cox regression models to examine data from individuals nested within ZIP-code areas and states, analysing individual-level risk factors and neighbourhood-level socioeconomic predictors in addition to adjusting for area-level clustering.Results
Of 81,171 eligible women followed for 496,709 person-years, 778 (0.96%) developed EC. The risk of EC risk approximately thrice as high among women aged 50-59 years (adjusted hazard ratio (aHR) = 2.92; 95% confidence interval (CI) = 2.20-3.88), 60-69 years (aHR = 2.97; 95% CI = 2.21-4.00), and ≥70 years (aHR = 2.86; 95% CI = 2.02-4.06) than among women under 40 years of age. Non-Hispanic White women had a 44% higher risk than non-Hispanic Black women (aHR = 1.44; 95% CI = 1.15-1.80). Obesity was associated with more than twice the risk of EC (aHR = 2.16; 95% CI = 1.85-2.52), while diabetes was associated with a 27% higher risk (aHR = 1.27; 95% CI = 1.06-1.51).Conclusion
Individual-level factors, particularly age and obesity, were the main predictors of EC incidence. Prevention efforts should prioritise obesity reduction, age-specific screening awareness, and lifestyle modifications.
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BibTeX
@article{adekanmbi2026risk,
title = {{Risk factors for endometrial cancer incidence and regional and ethnic disparities in the USA.}},
author = {Victor Adekanmbi and Fangjian Guo and Jiefei Wang and Angela Zhang and Christine H Wang and Thao N Hoang and Itunu Sokale and Olalekan Uthman and Abbey B Berenson},
journal = {Journal of global health},
year = {2026},
month = oct,
doi = {10.7189/jogh.16.04368},
url = {https://europepmc.org/article/MED/42924636},
note = {CC BY},
}
RIS
TY - JOUR
TI - Risk factors for endometrial cancer incidence and regional and ethnic disparities in the USA.
AU - Victor Adekanmbi
AU - Fangjian Guo
AU - Jiefei Wang
AU - Angela Zhang
AU - Christine H Wang
AU - Thao N Hoang
AU - Itunu Sokale
AU - Olalekan Uthman
AU - Abbey B Berenson
PY - 2026
DA - 2026/10/23
JO - Journal of global health
DO - 10.7189/jogh.16.04368
UR - https://europepmc.org/article/MED/42924636
AB - Background Endometrial cancer (EC) is the most common gynaecologic cancer in the USA and a major cause of cancer-associated mortality among women. We aimed to identify the independent contributions of individual- and contextual-level factors to EC incidence.Methods We conducted a longitudinal retrospective cohort study using anonymised data from women aged 18 years and above without EC included in the All of Us Research database before 1 January 2017. We followed participants from study entry until October 2023 (median follow-up = 6.6 years). We used mixed-effects Cox regression models to examine data from individuals nested within ZIP-code areas and states, analysing individual-level risk factors and neighbourhood-level socioeconomic predictors in addition to adjusting for area-level clustering.Results Of 81,171 eligible women followed for 496,709 person-years, 778 (0.96%) developed EC. The risk of EC risk approximately thrice as high among women aged 50-59 years (adjusted hazard ratio (aHR) = 2.92; 95% confidence interval (CI) = 2.20-3.88), 60-69 years (aHR = 2.97; 95% CI = 2.21-4.00), and ≥70 years (aHR = 2.86; 95% CI = 2.02-4.06) than among women under 40 years of age. Non-Hispanic White women had a 44% higher risk than non-Hispanic Black women (aHR = 1.44; 95% CI = 1.15-1.80). Obesity was associated with more than twice the risk of EC (aHR = 2.16; 95% CI = 1.85-2.52), while diabetes was associated with a 27% higher risk (aHR = 1.27; 95% CI = 1.06-1.51).Conclusion Individual-level factors, particularly age and obesity, were the main predictors of EC incidence. Prevention efforts should prioritise obesity reduction, age-specific screening awareness, and lifestyle modifications.
SN - 2047-2978
SN - 2047-2986
ER -