Residential context showed a significant relationship with survival among Black women diagnosed with epithelial ovarian cancer, according to study findings published in JAMA Network Open. Black women who lived in more socially vulnerable communities faced higher risks of death than those in less vulnerable areas.
“We expected residential context to influence outcomes, but what surprised us was how much stronger the impact was for Black women,” said lead study author Francesmary Modugno, PhD, MS, MPH, Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh School of Medicine. “Our findings suggest that it's not simply where someone lives. The interaction between a woman's lived experience and her residential environment may be helping drive these persistent disparities,” added Dr. Modugno, who is part of The Women’s Cancer Research Center, a collaboration between the UPMC Hillman Cancer Center and Magee-Womens Research Institute.
Study Methods
Researchers conducted a retrospective, observational cohort study of 509 Black women and 2,035 White adult women with epithelial ovarian cancer who were diagnosed between January 2000 and May 2023. Patients were followed through June 2024 at the University of Alabama at Birmingham.
The researchers assessed residential context in relation to racial disparities in epithelial ovarian cancer survival, with residential context defined at the census tract level based on the 2020 Social Vulnerability Index.
Key Findings
Black women were more likely to be diagnosed with more advanced disease than White women (68% vs 62.6%) and were also less likely to have high-grade serous cancers (50.3% vs 53.2%).
Additionally, Black women had worse overall survival than White women (adjusted hazard ratio [aHR] = 1.45; 95% confidence interval [CI] = 1.28–1.64).
Women who lived in areas of greater social vulnerability tended to have worse overall survival (aHR = 1.20; 95% CI = 1.06–1.35). The trend was significantly worse for Black women (aHR = 1.77; 95% CI = 1.49–2.10) vs White women (aHR = 1.10; 95% CI = 0.96–1.26), which amounted to a 32.5% greater hazard than expected.
Black women who lived in low (aHR = 1.20; 95% CI = 1.01–1.44) and high (aHR = 1.60; 95% CI = 1.32–1.94) Social Vulnerability Index areas demonstrated higher risks for death vs White women living in similar areas.
No pure mediation effect was found by Social Vulnerability Index on the race-mortality association. More than 15% of the race-mortality excess relative risk was considered attributable to mediated interactions between race and the Social Vulnerability Index.
A total 40.3% of the race-mortality excess relative risk was linked to living in areas of greater social vulnerability.
“Our findings reinforce that we must better understand and address the barriers patients face in their communities and ensure that every woman has equitable access to high-quality care,” said senior author Rebecca C. Arend, MD, MSPH, Associate Professor of Gynecology Oncology in the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham and Associate Director of Clinical Research at the O’Neal Comprehensive Cancer Center. “Translating research into meaningful improvements in cancer outcomes is only possible through strong collaborations among academic medical centers, researchers and community partners.”
The study authors concluded that more detailed studies are needed of residential and individual nonbiological factors in relation to epithelial ovarian cancer survival to identify possible interventions to reduce poor patient outcomes.
DISCLOSURES: This study was funded by grants from the National Institutes of Health, the Congressionally Directed Medical Research Program, and the Janet Burroughs Ovarian Cancer Foundation. Dr. Leath reports receiving grants from AbbVie, Imunon, and Volastra Therapeutics and serving on advisory boards for Immunogen and GenMab outside the submitted work. Dr. Toboni reported receiving therapeutic agents from GlaxoSmithKline and Exelixis for use in a clinical trial and personal fees from Caris Life Sciences and OncLive outside the submitted work. Dr. Arend reports receiving consulting fees from Merck Sharp & Dhome, 92 Biotech, and Corcept Therapeutics, serving on the advisory board of AstraZeneca, and receiving therapeutic agents from Immunogen, AbbVie, Champions Oncology, GSK, Exelixis, Artera, and Faeth Therapeutics for use in clinical trials outside the submitted work. No other disclosures were reported.
