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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by NIH: NCI: R01CA237318 The authors received support from this grant for the work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The AACES2 study has ethical approval via the Western IRB (IRB Registration #: IRB00000533) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data used in this study is protected health information and could be made available if IRB approval is sought for the applicant.