Journal of Global Health · Oct 23, 2026

Risk factors for endometrial cancer incidence and regional and ethnic disparities in the USA

By Adekanmbi V, Guo F, Wang J et al.

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.

doi.org/10.7189/jogh.16.04368Open accessPubMed 42924636Populations