Area Deprivation Indices (ADIs) rank neighborhoods by affluence and resources.
We examined state and national-level ADIs among 184 ovarian cancer cases.
ADIs were correlated, but were not related to any cancer characteristics.
Higher ADIs were associated with significantly greater risks of death.
Neighborhood deprivation may negatively impact ovarian cancer prognosis.
While individual-level measures of socioeconomic status have been well-studied in relation to ovarian cancer survival, no studies to date have examined both state and national-level Area Deprivation Indices (ADIs), which incorporate neighborhood affluence and resources.
We abstracted clinical data from medical records for ovarian cancer cases from the Vanderbilt University Medical Center and obtained ADIs from the Neighborhood Atlas®. Associations with clinical characteristics were assessed with Spearman correlations and Kruskal-Wallis tests; associations with progression-free survival (PFS) and overall survival (OS) were assessed with Cox proportional-hazards regression.
Among 184 cases, state and national ADIs were highly correlated, but not related to any cancer characteristics. In multivariable adjusted regression models, both were significantly associated with OS; each decile increase in state or national ADI corresponded to a 9 % or 10 % greater risk of death, respectively.
Increasing area-level deprivation may negatively impact ovarian cancer survival.
Ovarian cancer accounts for 5 % of all cancer deaths among women in the United States (US) and is generally diagnosed at late stage, when prognosis is poor. In large studies, individual-level measures of socioeconomic status (SES) have been associated with advanced stage of disease at diagnosis, receipt of sub-standard treatment, and worse ovarian cancer survival [ ]. In addition to individual-level measures of SES, such as income and health insurance, area-level measures also influence health outcomes and mortality through a variety of factors, including safety, social support, access to care, food availability, environmental exposures, and chronic stress [ ]. However, evaluations of neighborhood-level socioeconomic measures and ovarian cancer survival are limited. A small number of studies have shown that neighborhood SES or deprivation is associated with clinical characteristics of advanced or aggressive ovarian cancer (e.g. high-grade), type of oncologic care, and poor survival [ ]. However, prior indices were either developed for a specific geographic location, ranging from the county to state level, or were based on a limited number of measures (<10) of neighborhood SES from US Census tract data [ ].
The Area Deprivation Index (ADI) from the Neighborhood Atlas® provides a robust way to rank neighborhoods by disadvantage that enables comparison across the US; it consolidates 17 neighborhood-level measures (including education, employment, housing-quality and poverty) from Census block and American Community Survey (ACS) data and uses the Census Block Group, considered the closest approximation to a neighborhood, as the geographic unit of construction [ , ]. State ADI ranges in deciles from 1 (least) to 10 (most deprived), while national ADI is in percentiles (1–100, least to most deprived). Accordingly, higher ADIs represent more disadvantaged areas. While higher ADI has previously been linked to a number of health outcomes, no studies to date have focused on associations with ovarian cancer prognosis [ , ]. As prior studies specifically evaluating ovarian cancer survival and neighborhood deprivation have included geographically or otherwise limited area-level deprivation measures, we undertook this retrospective survival study to evaluate if national and state ADI rankings were associated with clinical characteristics or patient prognosis among a well-characterized cohort of ovarian cancer cases.