The impact of neighborhood disorder on ovarian cancer survival in African American women

Abstract Ovarian cancer (OC) is the fifth-leading cause of cancer deaths in women in the US. While the incidence of ovarian cancer in Black women is 25% lower than in White women, the 5-year survival for Black women is 10% lower than in White women. Recent evidence suggests that health disparities can be partly explained by neighborhood social and environmental factors such as disadvantage or disorder. To test whether objective neighborhood (dis)order is associated with OC survival we developed a novel approach using Google Street View (GSV) to estimate a measure of neighborhood disorder (ND) at the block group level within the largest multi-site cohort study of Black women diagnosed with OC (AACES) between 2010 and 2015. 592 AACES participants were enrolled and geocoded residing in 544 unique block groups largely concentrated in the southern US at their time of diagnosis. We randomly sampled 5 unique street address locations in each block group and adapted an online application, the Computer Assisted Neighborhood Visual Assessment System (CANVAS), that uses Google Street View to conduct virtual audits of the neighborhood environment at these points. We trained and standardized auditors to conduct two independent audits per location, for a total of 5,440 audits. Audit questions assessed the presence of different types of land use, quality of the built structures, and presence of other markers of ND. To understand the underlying patterns in the audit data, we conducted an exploratory factor analysis that identified 5 distinct neighborhood factors: developmental intensity, development age, neighborhood order, land use, and green/blue space. A score for each block group was calculated for each factor and assigned to residents of that block group. The neighborhood order factor included the condition of residential units and yards, as well as the presence of abandoned residential units and empty alcohol containers. The blue/green-space element included the presence of open spaces, recreational facilities, agricultural and waterfront land uses, and trees lining the streets. Survival analysis using Cox Proportional Hazards models was completed, focused on the neighborhood disorder and green/blue-space scores. After adjusting for age, income, education, comorbidity, and state of residence, higher neighborhood order scores were non-significantly associated with longer survival among participants (Hazard Ratio (HR): 0.95, 95% CI: 0.84-1.08). Similarly, higher green/blue space scores were also non-significantly associated with longer survival (HR: 0.92, 95%CI: 0.74-1.15), after adjustment. We observed that OC survival was longer among residents of block groups with higher neighborhood order scores and higher blue/green space scores, though we cannot rule out chance in these associations. Future research should explore mechanisms by which neighborhood features might affect ovarian cancer survival. Citation Format: Christopher Pierson, Steve J. Mooney, Andrew B. Lawson, Joellen M. Schildkraut, Edward S. Peters. The impact of neighborhood disorder on ovarian cancer survival in African American women [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C094.