Cancer
Quantifying the impacts of social determinants of health on survival among Black women with epithelial ovarian cancer in the United States Theresa Hastert* Courtney Johnson Theresa Hastert Anthony Alberg Andrew Lawson Lauren Peres Joellen Schildkraut
Survival among Black women with epithelial ovarian cancer (EOC) is poor and investigating unique contributors of these poor outcomes can be considered through a social determinants of health (SDOH) framework. Using survey response and geocoded data from a population-based study of Black women with EOC (N=433), we quantified 5 SDOH domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, & social and community context. We classified relevant variables into each domain and conducted a factor analysis to identify the sufficient principal components. We ran hierarchical clustering on these principal components, creating one categorical variable per SDOH domain. To measure the association with survival, we then fit Cox proportional hazards models for each domain, adjusting for stage and age at diagnosis and allowing the baseline hazard to vary by histotype. The strongest predictor of survival among Black women with EOC was economic stability, clustered into 3 levels: (1) low income & high proportions receiving disability, (2) middle income & high proportions of retired women, (3) high income & high proportions employed full time. Compared to the low-income group, survival was better among women in the second/middle income group (HR: 0.74, 95% CI: 0.55, 1.00) and those in the third/ high income group (HR: 0.68, 95% CI: 0.49, 0.93; p-trend=0.02). Living in a more densely populated area, regardless of SES, was associated with about 20% better survival (p=0.09), and survival was about 35% worse for women with incomplete/infrequent health insurance than for women with privately funded health insurance (p=0.08). The relationships between the social context or education and survival were null. The use of dimension reduction enabled us to quantify SDOH into easily interpretable single variables. Economic stability was the SDOH most strongly associated with survival among Black women with EOC in this study.