Increasing Area Deprivation Index negatively impacts ovarian cancer survival

1

Background

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 [ 12345678 ]. 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 [ 9 ]. 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 [ 10111213 ]. 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 [ 101112 ].

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 [ 14 , 15 ]. 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 [ 14 , 15 ]. 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.