Residential context may be more strongly associated with survival among Black women with epithelial ovarian cancer and may partially explain persistent racial disparities in outcomes.
Investigators analyzed overall survival outcomes among 509 Black women and 2,035 White women with epithelial ovarian cancer treated between January 2000 and May 2023. The patients were followed through June 2024. Residential context at diagnosis was assessed using the 2020 Social Vulnerability Index (SVI) at the census-tract level, with areas at or above the 75th national percentile classified as having high social vulnerability. The models accounted for race, age at diagnosis, decade of diagnosis, cancer stage, and histologic type.
Black women had 45% higher adjusted odds of mortality compared with White women. They also were more likely to live in areas with greater social vulnerability, with a median SVI of 0.78 vs 0.48 among White women. Across the overall cohort, residence in a high-SVI area was associated with 20% higher adjusted odds of mortality compared with residence in a low-SVI area.
The association between residential context and survival differed by race. Compared with White women living in low-SVI areas, Black women living in high-SVI areas had 77% higher adjusted odds of mortality. White women living in high-SVI areas had 10% higher adjusted odds, which was not statistically significant. The investigators reported that the combination of identifying as Black and having high social vulnerability was associated with 33% greater odds of mortality than expected from the separate associations of race and SVI.
Lower neighborhood vulnerability did not eliminate the racial survival disparity. Black women residing in low- and high-SVI areas had 20% and 60% higher adjusted odds of mortality compared with White women living in similar areas.
Mediation analyses suggested that residential vulnerability did not just mediate the association between race and mortality. The investigators found no statistically significant pure mediation effect of SVI. Instead, 16% of the excess relative risk was attributed to an interaction between race and SVI, while 40% operated through pathways involving SVI. In a separate exploratory analysis, 18% of the modeled association between race and survival was attributed to SVI, with the remaining 82% attributed to other pathways.
Because the study was observational, the investigators could not establish causality. Data came from a single tertiary cancer center, and 97% of patients lived in Alabama, potentially limiting generalizability. Because the study included only Black and White women, the findings cannot be generalized to patients of other races.
The investigators also applied 2020 SVI data to patients diagnosed between 2000 and 2023, which may have misclassified historical neighborhood conditions. The registry lacked information on treatment regimens, tumor mutations, comorbidities, and patient-level factors such as employment, income, education, and housing. Experiences such as discrimination, clinician bias, and social isolation were not captured by residential context, leaving the possibility of residual confounding.
“[A] more vulnerable residential setting has a greater negative association in Black women and may partially explain racial disparities in [epithelial ovarian cancer] survival,” wrote lead study author Francesmary Modugno, PhD, MPH, of the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh School of Medicine, and colleagues.
Full disclosures of the study authors can be found in the study.
Source: JAMA Network Open
