Residential Context May Contribute to Racial Disparities in Ovarian Cancer Survival
By: Wendy LaGrego
Posted: Thursday, October 22, 2026
Residential social vulnerability was associated with poorer overall survival among women with epithelial ovarian cancer, with a greater adverse association observed among Black women than White women, according to findings from a retrospective cohort study reported by Francesmary Modugno, PhD, MPH, of the University of Pittsburgh School of Medicine, and colleagues in JAMA Network Open.
Study Population and Methods
The study included 2,544 women aged 18 years or older who were diagnosed with epithelial ovarian cancer between January 2000 and May 2023 and treated at the University of Alabama at Birmingham, part of the O’Neal Comprehensive Cancer Center. Patients were followed through June 2024. Of the participants, 509 were Black and 2,035 were White.
Residential context was assessed using the 2020 Social Vulnerability Index (SVI), which incorporates census tract–level measures of socioeconomic status, household characteristics, racial and ethnic minority status, and housing and transportation. Areas at or above the 75th national SVI percentile were classified as having high social vulnerability.
The primary outcome was overall survival. Cox proportional hazards models were used to evaluate associations between residential context and mortality, adjusting for race, age at diagnosis, disease stage, histologic type, and decade of diagnosis. Mediation analyses examined the potential contribution of residential context to racial survival disparities.
Residential Context and Survival Disparities
Black women were more likely than White women to have stage III or IV disease at diagnosis (68.0% vs 62.6%) and to reside in areas of greater social vulnerability (median SVI score = 0.78 vs 0.48). During follow-up, 1,736 deaths occurred, including 358 among Black women and 1,378 among White women.
Black women had significantly poorer overall survival than White women (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI] = 1.28–1.64). After adjustment for residential context, the disparity was attenuated but remained significant (adjusted HR = 1.37, 95% CI = 1.21–1.56).
Across the overall cohort, residence in areas of high social vulnerability was associated with an increased hazard of death compared with residence in areas of low vulnerability (adjusted HR = 1.20; 95% CI = 1.06–1.35). The association was particularly pronounced among Black women. Compared with White women residing in low-vulnerability areas, Black women in high-vulnerability areas had a 77.1% greater hazard of death (adjusted HR = 1.77, 95% CI = 1.49–2.10), whereas White women in high-vulnerability areas did not have a statistically significant increase in mortality risk (adjusted HR = 1.10, 95% CI = 0.96–1.26).
Black women had significantly greater hazards of death than White women even when comparisons were restricted to those living in similarly vulnerable areas. The adjusted HRs were 1.20 (95% CI = 1.01–1.44) in low-vulnerability areas and 1.60 (95% CI = 1.32–1.94) in high-vulnerability areas.
Mediation analyses indicated that 40.3% (95% CI = 15.7%–61.8%) of the excess relative mortality risk associated with race operated through pathways involving social vulnerability, including interactions between race and residential context. However, residential context alone did not fully explain the observed survival disparities.
The investigators found that residential context had a stronger association with epithelial ovarian cancer survival among Black women and may partially explain racial disparities in outcomes.
“More detailed studies of residential and individual nonbiological factors associated with [epithelial ovarian cancer] survival are needed to identify interventions to reduce poor outcomes, especially for Black women,” they concluded.
DISCLOSURE: The study was funded by the National Institutes of Health, the Congressionally Directed Medical Research Program, and the Janet Burroughs Ovarian Cancer Foundation. For full disclosures of the study authors, visit jamanetwork.com.
