Black Women with Ovarian Cancer in Vulnerable Neighborhoods Experience Worse Survival Outcomes

Findings from a retrospective cohort study published in JAMA Network Open showed that living in a socially vulnerable neighborhood was associated with significantly worse overall survival (OS) among women with epithelial ovarian cancer, with a disproportionately greater negative association among Black women than White women.¹ The study found that Black women had a 45% higher risk of death than White women overall, and that women in the most socially vulnerable neighborhoods had a 20% higher risk of death than those in less vulnerable areas.

What did the study find about neighborhood vulnerability and ovarian cancer survival?

Among 2544 women with epithelial ovarian cancer treated at the O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham, 509 were Black and 2035 were White. Black women had significantly worse OS than White women (adjusted HR [aHR], 1.45; 95% CI, 1.28-1.64). After adjusting for residential context, this association was attenuated but remained significant (aHR, 1.37; 95% CI, 1.21-1.56). Living in a high social vulnerability index (SVI) area was associated with worse survival independent of race (aHR, 1.20; 95% CI, 1.06-1.35). A total of 1736 deaths occurred in the study; among the Black and White populations, 358 (70.3%) and 1378 patients (67.7%) died, respectively.

More than half of deaths among Black women (56.1%) occurred in those from high-SVI neighborhoods, compared with 18.9% of deaths among White women. Notably, Black women were more likely to reside in areas of greater social vulnerability, with a median SVI score of 0.78 (IQR, 0.58-0.90), compared with 0.48 (IQR, 0.27-0.70) in White patients.

“We expected residential context to influence outcomes, but what surprised us was how much stronger the impact was for Black women,” said Francesmary Modugno, PhD, MS, MPH, professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh and senior author of the study, in a press release.² “Our findings suggest that it’s not simply where someone lives. The interaction between a woman’s lived experience and her residential environment may be helping drive these persistent disparities.”

How did race and neighborhood vulnerability interact in this study?

The association between SVI and survival differed significantly by race. Compared with White women in low-SVI areas, Black women in low-SVI areas had a 20% higher hazard of death (aHR, 1.20; 95% CI, 1.01-1.44), and Black women in high-SVI areas had a 60% higher hazard of death (aHR, 1.60; 95% CI, 1.32-1.94). This exceeded what would be expected from the main effects of SVI and race alone (ratio of HRs, 1.33; 95% CI, 1.02-1.72). Mediation analyses found no pure mediation effect of SVI on the race-mortality association, but 16.4% (95% CI, 2.1%-33.3%) of the excess relative risk was attributable to a mediated interaction between race and SVI. Of the excess relative risk, 40.3% (95% CI, 15.7%-61.8%) operated through pathways involving residential vulnerability overall.

How was the study designed?

Investigators analyzed data from the O’Neal Cancer Registry for women 18 years or older diagnosed with epithelial ovarian cancer between January 1, 2000, and May 31, 2023, with follow-up through June 30, 2024. Residential context was assessed by linking each patient’s census tract to the CDC/ATSDR 2020 Social Vulnerability Index; tracts at or above the 75th national percentile classified as high vulnerability, and those below the 75th percentile were considered low. Cox proportional hazards models with cluster-robust standard errors were adjusted for age at diagnosis, decade of diagnosis, stage, and histologic type. Black women were more likely to be diagnosed at an advanced stage (68.0% vs 62.6%) and less likely to have high-grade serous tumors (50.3% vs 53.2%).

The primary outcome of the study was OS.

How could these findings shape cancer care delivery?

The study authors suggested that health systems could incorporate neighborhood-level tools such as the SVI into cancer care planning to identify patients at greatest risk and connect them with patient navigation, transportation assistance, childcare support, and survivorship resources.² The current findings build on 2025 data from UPMC Hillman Cancer Center that first linked neighborhood social vulnerability to ovarian cancer survival in a predominantly White cohort.³ The authors noted that because the current cohort was drawn from a single center in Alabama, the findings will need to be validated in other regions and among other racial and ethnic groups.

“Our findings reinforce that we must better understand and address the barriers patients face in their communities and ensure that every woman has equitable access to high-quality care,” stated Rebecca Arend, MD, MSPH, associate professor of gynecologic oncology at University of Alabama in Birmingham, and a study coauthor, in the press release.² “Translating research into meaningful improvements in cancer outcomes is only possible through strong collaborations among academic medical centers, researchers and community partners.”

References

1. Modugno F, O'Brien E, Cai C, et al. Residential context and survival disparities in Black and White women with ovarian cancer. JAMA Netw Open. 2026;9(8):e2627722. doi:10.1001/jamanetworkopen.2026.27722
2. Where women live may influence ovarian cancer survival, especially among Black women. News release. UPMC. August 10, 2026. Accessed August 11, 2026. https://tinyurl.com/yv9c2vtk
3. Hicks A, Borho L, Elishaev E, et al. All-cause mortality and neighborhood social vulnerability among women with ovarian cancer. Gynecol Oncol. 2025;195:26-33. doi:10.1016/j.ygyno.2025.02.014