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.

To examine whether there is an association of residential context with racial disparities in EOC survival.

This 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, part of the O'Neal National Cancer Institute Designated Comprehensive Cancer Center.

The primary outcome was all-cause mortality. Residential context was assessed at the census tract level using the 2020 Social Vulnerability Index (SVI). Data analyses were conducted between July 2024 and May 2026.

Of the 2544 female patients, 509 were Black (median [IQR] age, 62 [54-70] years) and 2035 were White (median [IQR], 63 [54-72] years). Black women were more likely than White women to be diagnosed with EOC at a more advanced stage (346 [68.0%] vs 1274 [62.6%]) and less likely to have high-grade serous cancers (256 [50.3%] vs 1083 [53.2%]). Black women also had worse overall survival (adjusted hazard ratio [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 (AHR, 1.77; 95% CI, 1.49-2.10) than for White women (AHR. 1.10; 95% CI, 0.96-1.26), indicating a 32.5% greater hazard than expected from the main effects of SVI and race. Black women residing in both low (AHR. 1.20; 95% CI, 1.01-1.44) and high (AHR, 1.60; 95% CI, 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.

In this cohort study, residential context had a stronger association with survival for Black women and may partially explain the persistent racial disparities in EOC survival. More detailed studies of residential and individual nonbiological factors associated with EOC survival are needed to identify interventions to reduce poor outcomes, especially for Black women.