- Epithelial ovarian cancer is the most lethal gynecologic cancer, with 5-year survival rates of 50% overall and 40% for Black women.
- In a retrospective cohort study, living in areas with a high Social Vulnerability Index was associated with worse overall survival among women with epithelial ovarian cancer, particularly Black women.
- Black women had significantly greater hazards of death versus their white counterparts whether they lived in an area of low or high social vulnerability.
Living in areas of greater social vulnerability was linked to worse overall survival among women with epithelial ovarian cancer, particularly Black women, a retrospective cohort study suggested.
Overall, living in areas with a high Social Vulnerability Index (SVI) was associated with worse overall survival (adjusted HR 1.20, 95% CI 1.06-1.35), with a significantly greater adverse effect for Black women (aHR 1.77, 95% CI 1.49-2.10) compared with white women (aHR 1.10, 95% CI 0.96-1.26).
This indicated a 32.5% greater hazard than expected from the main effects of SVI and race, noted Francesmary Modugno, PhD, MPH, of the University of Pittsburgh School of Medicine and Magee-Womens Hospital, and colleagues.
In general, Black women had worse overall survival compared with white women (aHR 1.45, 95% CI 1.28-1.64). This disparity was attenuated but remained after adjusting for residential context (aHR 1.37, 95% CI 1.21-1.56), they wrote in JAMA Network Open.
Moreover, Black women had significantly greater hazards of death versus their white counterparts whether they lived in an area of low (aHR 1.20, 95% CI 1.01-1.44) or high social vulnerability (aHR 1.60, 95% CI 1.32-1.94).
“This is the first study to look at how where one lives may be impacting ovarian cancer survival using a large cohort of Black and white women all treated at a single academic medical center, which implies that the women received equivalent guideline-concordant care,” Modugno told MedPage Today.
Melissa Simon, MD, MPH, an ob/gyn at Northwestern Medicine in Chicago, told MedPage Today that these findings reflect “place-based, environmental, and social factors’ substantial impact on health outcomes.”
“A lot more research is needed to parse out the underlying drivers of cancer health disparities, especially in women’s cancers across the U.S.,” she added.
Epithelial ovarian cancer is the most lethal gynecologic cancer, with a 5-year survival rate of 50%. For Black women, survival at 5 years is 40% — the lowest of any race.
Modugno noted that the survival disparity between Black and white patients with epithelial ovarian cancer is well known, even after controlling for clinical factors. Previous research has shown that individual factors like body mass index play a role in epithelial ovarian cancer survival, as do social determinants of health.
“Understanding how residential context contributes to EOC survival disparities is an essential step in designing interventions that promote equity in cancer care and survivorship,” the authors wrote. “Leveraging SVI or similar neighborhood-level indexes within health systems and cancer programs could enable proactive identification of patients at greatest risk for poor EOC [epithelial ovarian cancer] outcomes, inform targeted deployment of navigation and supportive services, and guide outreach, screening, and survivorship resources toward highly vulnerable communities.”
For this observational study, Modugno and team utilized data from the O’Neal Comprehensive Cancer Center Cancer Registry for women diagnosed with epithelial ovarian cancer from January 2000 through May 2023, with follow-up through June 2024. Residential context was assessed at the census tract level using the 2020 SVI.
In all, there were 2,544 patients, of whom 509 were Black (median age 62) and 2,035 were white (median age 63).
Black women were more likely to be diagnosed with epithelial ovarian cancer at a more advanced stage compared with white women (68% vs 62.6%), and less likely to have high-grade serous tumors (50.3% vs 53.2%).
Mediation analyses found that 16.4% of the race-mortality excess relative risk was attributable to mediated interactions between race and SVI but did not find any pure mediation effect of SVI alone on the race-mortality association. Moreover, 40.3% of the race-mortality excess relative risk operated through pathways involving the SVI.
Together, these findings suggest that social vulnerability “may partially explain the survival gap through its interaction with race rather than serving as an intermediate step,” Modugno and colleagues wrote.
They pointed to several limitations to their study, including the potential for survivorship or referral bias and the large number of cases with incomplete data. The single-center design and exclusion of races other than Black and white may limit the generalizability of results. The SVI of census tracts could have shifted over time, and other important factors, like patients’ experiences of discrimination, bias, and social isolation, are not captured by residential context.
Modugno said the team is now looking at how environmental factors, such as air and water pollution, may lead to differences in ovarian cancer outcomes.
