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Observational Study
. 2025 Jan:192:32-39.
doi: 10.1016/j.ygyno.2024.10.030. Epub 2024 Nov 21.

Association of neighborhood social vulnerability with ovarian cancer survival

Lauren Borho  1 , Esther Elishaev  2 , Riyue Bao  3 , Emily O'Brien  4 , Kaitlyn Dinkins  5 , Jessica Berger  1 , Michelle Boisen  1 , John Comerci  1 , Madeleine Courtney-Brooks  1 , Robert P Edwards  1 , Alison Aunkst Garrett  1 , Joseph L Kelley  1 , Jamie Lesnock  1 , Haider S Mahdi  1 , Alexander Olawaiye  1 , Shannon Rush  1 , Paniti Sukumvanich  1 , Sarah Taylor  1 , Ritu Aneja  6 , Lyse Norian  6 , Rebecca C Arend  5 , Francesmary Modugno  7
Affiliations
Observational Study

Association of neighborhood social vulnerability with ovarian cancer survival

Lauren Borho et al. Gynecol Oncol. 2025 Jan.

Abstract

Objective: Social determinants of health (SDOH) impact cancer outcomes. The CDC Social Vulnerability Index (SVI) integrates scores for four neighborhood-based SDOH domains (socioeconomic status, household characteristics, minority status, and housing type/transportation) to assess neighborhood social vulnerability (NSV). While NSV has been associated with overall cancer mortality and lung, breast, colon, and endometrial cancer-specific mortality, the relationship between NSV as defined by the SVI and ovarian cancer outcomes remains unknown.

Methods: We used data from 177 patients enrolled in an observational ovarian cancer cohort study from October 2012 through September 2022. All patients underwent debulking surgery and completed an entire course of standard-of-care platinum-based chemotherapy. Follow-up was completed through May 2024. SVI was calculated using census tract at diagnosis. High NSV was defined as SVI in the top quartile of the cohort. Cox proportional hazard models assessed the association between NSV and progression-free (PFS) and overall (OS) survival.

Results: After accounting for demographic and clinical factors, high NSV was associated with significantly worse PFS (HR:2.31 [95% CI:1.48-3.61]; P < 0.001) and OS (HR:1.79 [95% CI:1.10-2.92]; P = 0.02), with neighborhood socioeconomic status associated with significantly worse PFS (HR:2.29 [95% CI:1.47-3.56]; P < 0.001) and OS (HR:1.71 [95% CI:1.04-2.80]; P = 0.03). Neighborhood housing type/transportation was also associated with significantly worse PFS (HR:1.65 [95% CI:1.07-2.55]; P = 0.02) and trended towards worse OS (HR:1.43 [95% CI: 0.80-2.33]).

Conclusion and relevance: Higher neighborhood social vulnerability is associated with worse outcomes among ovarian cancer patients. Validating these results in a population-based cohort and assessing programs to reduce neighborhood social vulnerability to improve ovarian cancer outcomes is warranted.

Keywords: Neighborhood social vulnerability; Outcomes; Ovarian Cancer; Social determinants of health; Social vulnerability index; Survival.

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Conflict of interest statement

Declaration of competing interest Arend: Consultant for Tempus; Advisory Board, Immunogen; Steering Committee, Merck; Advisory Board, Seagen; Advisory Board, Sutro; Advisory Board, GSK; Consultant, Mersana. Bao: PCT/US15/612657 (Cancer Immunotherapy), PCT/US18/36052 (Microbiome Biomarkers for Anti-PD-1/PD-L1 Responsiveness: Diagnostic, Prognostic and Therapeutic Uses Thereof), PCT/US63/055227 (Methods and Compositions for Treating Autoimmune and Allergic Disorders). Berger: Advisory Board, GSK. All other authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Progression-free survival according to neighborhood social vulnerability (NSV) among 177 newly diagnosed epithelial ovarian cancer cases. Survival functions from Cox Proportional hazard models adjusted for age, EOC histology, stage, optimally debulked status, and chemotherapy regimen. SVI: Social Vulnerability Index.
Fig. 2.
Fig. 2.
Overall survival according to neighborhood social vulnerability (NSV) among 177 newly diagnosed epithelial ovarian cancer cases. Survival functions from Cox Proportional hazard models adjusted for age, EOC histology, stage, optimally debulked status, and chemotherapy regimen. SVI: Social Vulnerability Index.
See this image and copyright information in PMC

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