Association of neighborhood social vulnerability with ovarian cancer survival

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

doi:10.1016/j.ygyno.2024.10.030

Association of neighborhood social vulnerability with ovarian cancer survival

Gynecol Oncol. 2024 Nov 21:192:32-39. doi: 10.1016/j.ygyno.2024.10.030. Online ahead of print.

Authors

Lauren Borho¹, Esther Elishaev², Riyue Bao³, Emily O'Brien⁴, Kaitlyn Dinkins⁵, Jessica Berger¹, Michelle Boisen¹, John Comerci¹, Madeleine Courtney-Brooks¹, Robert P Edwards¹, Alison Aunkst Garrett¹, Joseph L Kelley¹, Jamie Lesnock¹, Haider S Mahdi¹, Alexander Olawaiye¹, Shannon Rush¹, Paniti Sukumvanich¹, Sarah Taylor¹, Ritu Aneja⁶, Lyse Norian⁶, Rebecca C Arend⁵, Francesmary Modugno⁷

Affiliations

¹ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America.
² Department of Pathology, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America.
³ Department of Hematology/Oncology, University of Pittsburgh School of Medicine and Hillman Cancer Center, Pittsburgh, PA, United States of America.
⁴ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America; Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine and O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America.
⁵ Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine and O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America.
⁶ Department of Nutrition Sciences, University of Alabama at Birmingham School of Health Professions, Nutrition Obesity Research Center, and O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America.
⁷ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America; Women's Cancer Research Center, Magee-Womens Research Institute and Foundation and Hillman Cancer Center, Pittsburgh, PA, United States of America; Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States of America. Electronic address: modugnof@upmc.edu.

PMID: 39577071
DOI: 10.1016/j.ygyno.2024.10.030

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.