Objective:

To analyze the association between residential context and survival outcomes among Black and White women with epithelial ovarian cancer.

Approach:

• Study Design: Investigators analyzed overall survival outcomes among 509 Black women and 2,035 White women treated for epithelial ovarian cancer from January 2000 to May 2023, with follow-up through June 2024.
• Assessment Method: Residential context was assessed using the 2020 Social Vulnerability Index (SVI) at the census-tract level.
• Statistical Analysis: Models accounted for race, age at diagnosis, decade of diagnosis, cancer stage, and histologic type.

Key Findings:

• Black women had 45% higher adjusted odds of mortality compared to White women.
• Black women were more likely to live in areas with greater social vulnerability, with a median SVI of 0.78 vs 0.48 for White women.
• Residence in a high-SVI area was associated with 20% higher adjusted odds of mortality compared to low-SVI areas.
• Black women in high-SVI areas had 77% higher adjusted odds of mortality compared to White women in low-SVI areas.
• The combination of identifying as Black and having high social vulnerability was associated with 33% greater odds of mortality.
• Black women in low- and high-SVI areas had 20% and 60% higher adjusted odds of mortality compared to White women in similar areas.

Limitations:

• The study was observational, preventing the establishment of causality.
• Data was sourced from a single tertiary cancer center, with 97% of patients from Alabama, limiting generalizability.
• The study included only Black and White women, restricting applicability to other racial groups.
• Historical neighborhood conditions may have been misclassified due to applying 2020 SVI data to patients diagnosed between 2000 and 2023.
• Lack of data on treatment regimens, tumor mutations, comorbidities, and patient-level factors such as employment and education.
• Experiences like discrimination and clinician bias were not captured, leaving room for residual confounding.

Sources:

• JAMA Network Open