RESUMO
OBJECTIVE: Prior studies have demonstrated survival differences between Black women with endometrial cancer (EC) born in the US and Caribbean. Our objective was to determine if country of birth influences EC overall survival (OS) in disaggregated subpopulations of Black women. METHODS: Using the Florida Cancer Data System, women with EC diagnosed from 1981 to 2017 were identified. Demographic and clinical information were abstracted. Women who self-identified as Black and born in the US (USB), Jamaica (JBB), or Haiti (HBB) were included. Statistical analyses were performed using chi-square, Cox proportional hazards models, and Kaplan-Meier methods with significance set at p < 0.05. RESULTS: 3817 women met the inclusion criteria. Compared to USB, JBB and HBB had more high-grade histologies, more advanced stage disease, had a greater proportion of uninsured or Medicaid insured, and had a higher proportion of women who received chemotherapy (all p < 0.05). In multivariate analyses, age (HR 1.03 [1.02-1.05]), regional stage (HR 1.52 [1.22-1.89]), distant stage (HR 3.73 [2.84-4.89]), lymphovascular space invasion (HR 1.96 [1.61-2.39]), receipt of surgery (HR 0.47 [0.29-0.75]), and receipt of chemotherapy (HR 0.77 [0.62-0.95]) were independently associated with OS. Compared to USB, Haitian nativity was an independent negative predictor of OS when evaluating all histologies together (HR 1.54 [1.18-2.00]) and for endometrioid EC specifically (HR 1.77 [1.10-2.83]). Among women with serous EC, HBB had markedly worse median OS (18.5 months [13.4-46.5]) relative to USB (29.9 months [26.3-35.9]) and JBB (41.0 months, [34.1-82.6], p = 0.013). CONCLUSION: Country of birth is associated with endometrial cancer survival in Black women, with HBB demonstrating worse outcomes.
Assuntos
Carcinoma Endometrioide , Neoplasias do Endométrio , Feminino , Humanos , População Negra , Carcinoma Endometrioide/mortalidade , Carcinoma Endometrioide/terapia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/terapia , Haiti/epidemiologia , Grupos Raciais , Estados Unidos/epidemiologia , Negro ou Afro-Americano , Taxa de Sobrevida , JamaicaRESUMO
To date, there have been a plethora of punitive and diversion programs to address domestic violence around the world. However, the evaluative scholarship of such programs overwhelmingly reflects studies in developed countries while barely showcasing the realities of addressing domestic violence in developing countries. This paper features a multi-year (2008-2011) evaluation study that measured the fidelity of the United Nations Partnership for Peace (PfP) domestic violence diversion program in the Eastern Caribbean country of Grenada. Our findings illuminate organic engagement strategies that were built within existing multi-sectoral partnerships that included magistrate court judges, law enforcement officials, and social service agencies. Furthermore, we documented how the locally-devised implementation strategies ensured the program's fidelity within a resource-limited context. This paper contributes to the global evaluative scholarship, highlighting the lessons learned about implementing culturally-adapted and theoretically-driven domestic violence diversion within a developing country.