Abstract 5788: Area deprivation index and ovarian cancer survival: Preliminary findings for two validated measures
Authors: Hufnagel Demetra H. , Wilson Andrew J. , Yull Fiona E. , Hull Pamela C. , Schildkraut Joellen , Crispens Marta A. , Beeghly-Fadiel Alicia 
Published: September 2020

Abstract
Objective: Individual-level measures of socioeconomic status (SES), such as income and education, have been well-studied in relation to ovarian cancer survival. Emerging evidence suggests that area-level measures, which incorporate the affluence and resources of a neighborhood, may be significant drivers of these associations. Existing studies on the role of area-level deprivation and cancer outcomes are limited; no studies to date have examined validated state and national-level area-deprivation indices in the context of ovarian cancer. We therefore undertook this study to elucidate relationships between Area Deprivation Index (ADI), clinical characteristics, and ovarian cancer progression and survival.
Methods: We abstracted clinical data from electronic medical records for epithelial ovarian cancer cases from the Vanderbilt University Medical Center (VUMC). Patient addresses at the time of treatment were used to ascertain state and national ADIs based on 17 measures from the Census and American Community Survey, including regional education, employment, and housing-quality indices. We used Pearson's coefficient to quantify correlations between continuous variables and the Wilcoxon rank-sum test to assess associations between ADI and clinical characteristics. Associations with progression-free survival (PFS) and overall survival (OS) were quantified by hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional-hazards regression. P-values ≤ 0.05 were considered statistically significant.
Results: Among 183 epithelial ovarian cancer cases from the VUMC, state and national ADIs were highly correlated (r = 0.94, p &lt; 0.001). Neither were significantly associated with race, grade, stage, histologic subtype, platinum sensitivity, or residual disease after surgical debulking. The median state ADI was 5.0 (scale: 1-10) and the median national ADI was 61.5 (scale: 1-100). Cases with higher than median state or national ADIs, indicating living in an area with more deprivation, did not have significantly different PFS in crude or multivariable models or OS in crude models. However, after adjustment for age, race, stage of disease, and grade, having a higher ADI was associated with approximately 40% shorter OS (state: HR: 1.40, CI: 1.01-1.94; national: HR: 1.44, CI: 1.03-2.00).
Conclusions: Our preliminary findings support the hypothesis that increasing area-level deprivation negatively impacts ovarian cancer survival. Additional research to include additional clinical characteristics and replicate this association in a larger study population are currently underway.
Citation Format: Demetra H. Hufnagel, Andrew J. Wilson, Fiona E. Yull, Pamela C. Hull, Joellen Schildkraut, Marta A. Crispens, Alicia Beeghly-Fadiel. Area deprivation index and ovarian cancer survival: Preliminary findings for two validated measures [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5788.