4.5 Article

Deprivation and segregation in ovarian cancer survival among African American women: a mediation analysis

期刊

ANNALS OF EPIDEMIOLOGY
卷 86, 期 -, 页码 57-64

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ELSEVIER SCIENCE INC
DOI: 10.1016/j.annepidem.2023.07.001

关键词

Ovarian cancer; AACES 1 cohort; Survival; Diagnostic delay; Deprivation indices; Yost; ICE; Causal mediation; Bayesian; Structural equation

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This study assessed the impact of deprivation and segregation indices on the survival of self-identified Black women diagnosed with ovarian cancer. The results showed that high socioeconomic status-related indices were associated with increased survival, while the index of concentration at the extremes-race had no significant impact on overall survival. The study highlights the importance of area-level economic indices and urbanization index in the survival of Black women with ovarian cancer.
Purpose: 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 di-agnosed with ovarian cancer who enrolled in the African American Cancer Epidemiology Study.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 socioeconomic status-related indices have an association with in-creased survival, ranging from 25% to 56%. In contrast, index of concentration at the extremes-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 socioeconomic status neighborhoods are associated with increased survival with ovarian cancer using area-level economic indices such as Yost or index of concentration at the extremes-income. In addition, the Kolak urbanization index has a similar impact and highlights the importance of area-level deprivation and segregation as potentially modifiable social factors in ovarian cancer survival.(c) 2023 Elsevier Inc. All rights reserved.

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