All ETDs from UAB

Advisory Committee Chair

John W Waterbor

Advisory Committee Members

Rebecca C Arend

Gerald McGwin

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Public Health


Introduction. Social vulnerability (SV) refers to potential negative effects on communities caused by external stresses on human health. The CDC/ATSDR Social Vulnerability Index (SVI) scores communities on 15 social indicators in 4 themes: (1) socioeconomic status (SES), (2) household composition and disability, (3) minority status and language, and (4) housing type and transportation. An overall score ranging from 0 (least vulnerable) to 1 (most vulnerable) is calculated to estimate vulnerability. We investigated whether SV as measured by the SVI can explain why black endometrial cancer (EC) patients survive less well than do white EC patients. Methods. We studied the survival of 918 EC patients, 293 (32%) Black, and 625 (68%) Non-Black (90% White), treated from 2007-2022 at a tertiary-care cancer center in the Deep South. Demographic, clinical, and survival data were retrieved from electronic medical records. OS at 5 years was computed for Black and non-Black patients using Cox proportional hazards models. The relationship between level of social vulnerability (high, medium, or low tertile) and OS was assessed for each group by comparing the percent in the highest tertile for Blacks and non-Blacks. Results. Black EC patients had about double the percentage of high SV (67% vs 32%, p<0.0001) than did non-Black EC patients; and Black patients did not survive as well iv as non-Black patients. Blacks did worse than Whites for all themes, with all comparisons highly statistically significant: Theme 1: 71.3% vs 37.3%; Theme 2: 67.2% vs 50.2%; Theme 3: 17.4% vs 7.4%; Theme 4: 44.4% vs 23.2%. Within races, multivariate analysis showed that high SES vulnerability (Theme 1) was associated with worse OS for non-Black EC patients (HR 2.9, 95% CI 1.4-6.2), but not for Black patients (HR 0.97, 95%CI 0.28-3.28), independent of the other factors in the model. Other themes did not yield statistically significant findings. Conclusions. Higher social vulnerability among Black as compared to non-Black patients, was associated with lower OS. Non-Black patient survival was primarily driven by SES vulnerability. Further investigation of racial differences in social vulnerability components is warranted to understand the dynamics of race and SES determination of disparities in endometrial cancer survival.

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