All-cause mortality and neighborhood social vulnerability among women with ovarian cancer

Abstract

Objective: Neighborhood-level social determinants of health (N-SDoH) impact cancer survival. However, the relationship between N-SDoH and epithelial ovarian cancer (EOC) survival remains understudied.

Methods: We used data on all Pennsylvania residents diagnosed with EOC from 2000 to 2023 throughout the University of Pittsburgh Medical Center to assess the impact of N-SDoH on survival. We used the Social Vulnerability Index (SVI) to characterize four N-SDoH themes and overall N-SDoH vulnerability based on each case's census tract at diagnosis. High-SVI overall and by N-SDoH theme was defined as being in the 75th percentile in Pennsylvania for that metric. Cox proportional hazard models assessed the association between high-SVI and overall mortality.

Results: Among 4970 EOC cases, high-SVI overall was associated with later stage at diagnosis, greater residual disease, and a lower likelihood of receiving standard-of-care platinum-based therapy. High-SVI was also associated with a 13 % increased mortality hazard (adjusted-HR:1.13 95 %CI:1.02-1.25). The Household Characteristics, Racial and Ethnic Minority Status, and Housing Type and Transportation themes were also associated with increased mortality hazards (adjusted-HR[95 %CI]: 1.10[1.01-1.21], 1.23[1.08-1.39], 1.09[1.00-1.18], respectively). The Socioeconomic Status theme was associated with an increased mortality hazard of borderline significance (adjusted-HR 1.10, 95 %CI:0.99-1.23). The overall high-SVI association appeared similar when stratifying by race, although the number of Black cases was small (n = 168).

Conclusion: Higher neighborhood social vulnerability is associated with worse EOC survival. Replicating study findings in more diverse populations can help illuminate the neighborhood factors most influencing survival and support the design and testing of programs to reduce poor EOC outcome, especially within marginalized communities.

Keywords: Census tract; Ovarian cancer; Social determinants of health; Social vulnerability index; Survival.

Fig. 1.

Overall survival according to neighborhood social vulnerability as determined by the SVI among 4970 newly diagnosed epithelial ovarian cancer cases seen at UPMC HCC 2000–2023. Survival functions from Cox Proportional hazard models adjusted for age, race, EOC histology, stage, residual disease, use of platinum-based chemotherapy, and insurance type. SVI: Social Vulnerability Index; UPMC: University of Pittsburgh Medical Center; HCC: Hillman Cancer Center.