Retrospective, observational cohort study of residential context and survival disparities in Black and White women with ovarian cancer

Black women with epithelial ovarian cancer (EOC) have significantly worse survival than White women. How residential context contributes to these disparities is unclear. A retrospective, observational cohort study assessed women 18 years or older diagnosed with EOC between January 1, 2000, and May 31, 2023, and followed-up through June 30, 2024, at the University of Alabama at Birmingham. The primary outcome was all-cause mortality. Residential context was assessed at the census tract level using the 2020 Social Vulnerability Index (SVI). Of the 2544 patients, 509 were Black and 2035 were White. Black women were more likely than White women to be diagnosed with EOC at a more advanced stage, and less likely to have high-grade serous cancers. Black women had worse overall survival (aHR 1.45; 95% CI 1.28-1.64). Living in areas of greater social vulnerability was associated with worse overall survival (aHR 1.20; 95% CI 1.06-1.35), with a significantly greater adverse effect for Black women (1.77; 1.49-2.10) than for White women (1.10; 0.96-1.26), indicating a 32.5% greater hazard than expected from the main effects of SVI and race. Black women residing in low (aHR 1.20; 95% CI 1.01-1.44) and high (1.60; 1.32-1.94) SVI areas had significantly greater hazards of death compared with White women residing in similar SVI areas. Mediation analyses revealed no pure mediation effect of SVI on the race-mortality association, but a significant 16.4% (95% CI 2.1-33.3) of the race-mortality excess relative risk was attributable to mediated interactions between race and SVI. Overall, 40.3% (95% CI 15.7-61.8) of the race-mortality excess relative risk operated through pathways involving residing in areas of greater social vulnerability. The authors conclude that residential context had a stronger association with survival for Black women than for White women and may partially explain the persistent racial disparities in EOC survival.