Endometrial cancer outcomes among women with disabilities: treatment access and survival disparities using nationwide Korean data

Endometrial cancer incidence has risen rapidly in Korea, yet little is known about disparities in care among women with disabilities, a population at risk for unequal access to healthcare. This study investigated differences in cancer care and outcomes between women with and without disabilities. This nationwide retrospective cohort study linked the National Disability Database, the Korean Central Cancer Registry, and the National Health Insurance claims database. A total of 726 women with disabilities and 2,630 women without disabilities who were diagnosed with endometrial cancer were included. Multivariable Cox regression was used to estimate adjusted hazard ratios (aHRs) for all-cause mortality. Stage distribution at diagnosis did not differ significantly between women with and without disabilities. However, women with disabilities had lower chemotherapy receipt, while significantly lower surgery receipt was observed primarily among women with severe disabilities. After adjustment for demographic and clinical factors, women with disabilities had a 44% higher risk of all-cause mortality than women without disabilities (aHR 1.44, 95% CI 1.20–1.73), with the highest risk among those with mild physical/brain disabilities (aHR 1.54, 95% CI 1.21–1.96). Women with disabilities experienced disparities in endometrial cancer treatment and had a higher risk of all-cause mortality than women without disabilities. Addressing these gaps will require disability-sensitive strategies in cancer care delivery, including provider education, improved communication, transportation and financial support, and integration of medical and welfare systems to ensure equitable treatment access and reduce preventable mortality.