Deprivation and Segregation in Ovarian cancer survival among African American Women: a mediated analysis

Background: Deprivation and segregation indices are often examined as possible explanations for observed health disparities in population-based studies. In this study we assessed the role of recognized deprivation and segregation indices specifically as they affect survival in a cohort of self-identified Black women diagnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study (AACES). Methods: Mediation analysis was used to examine the direct and indirect effects between deprivation or segregation and overall survival, via a Bayesian structural equation model with Gibbs variable selection. Results: The results suggest that high SES -related indices have an association with increased survival, ranging from 25%-56%. In contrast, ICE-race does not have a significant impact on overall survival. In many cases, the indirect effects have very wide credible intervals, consequently the total effect is not well estimated despite the estimation of the direct effect. Conclusions: Our results show that black women living in higher SES neighborhoods are associated with increased survival with ovarian cancer, using area-level economic indices such as Yost or ICE-income. In addition, the KOLAK urbanization index has a similar impact, and the highlights importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.