Abstract B102: Contribution of comorbid conditions to racial and ethnic disparities in ovarian cancer survival
Authors: Collin Lindsay J. , Li Jia , Lee Valerie S. , Kavecansky Juraj , Garcia Christine , Diaz Carola Sanchez , Gomez Scarlett Lin , Doherty Jennifer A. , Bandera Elisa V. , Kushi Lawrence H. 
Published: December 2023

Abstract
Background: Ovarian cancer is the most lethal gynecologic cancer and the fifth leading cause of cancer-related mortality among women in the US. Racial and ethnic disparities in ovarian cancer outcomes exist, wherein non-Hispanic Black (NHB) women are 40% more likely to die compared with non-Hispanic White (NHW) women. Comorbidity burden is differential by race and ethnicity and has the potential to affect treatment and outcomes. Our objective was to evaluate the association between comorbidities, present at the time of diagnosis, and mortality, and to evaluate if comorbidities contributed to racial and ethnic disparities in mortality. Methods: The KP ROCS (Kaiser Permanente Research on Ovarian Cancer Survival) Study includes women diagnosed with invasive ovarian, fallopian, or peritoneal cancer between 2000 and 2018 at KP Northern California, older than 18 years and residing in California at diagnosis. Comorbidities were identified using ICD-9/10 and procedural codes up to five years preceding the ovarian cancer diagnosis. We computed hazard ratios (HRs) and 95% confidence intervals (CIs) associating individual comorbidities and the Charlson Comorbidity Index (CCI) with all-cause mortality, and the racial disparities (Hispanic, non-Hispanic Asian, and NHB vs. NHW) in all-cause mortality by comorbidity, adjusting for age and stage. Results: Of 4,910 ovarian cancer patients in the KP ROCS cohort, 605 (12%) are Hispanic, 672 (13%) are non-Hispanic Asian, 282 (5.5%) are NHB, and 3,321 (74%) are NHW. At diagnosis, NHB and Hispanic ovarian cancer patients were more likely to present with diabetes than non-Hispanic Asian and NHW women (NHB=16%, Hispanic=13% vs non-Hispanic Asian=10%, NHW=8%). Cardiovascular disease was more common among NHB women compared with other racial and ethnic groups (NHB=37% vs. Hispanic=26%, non-Hispanic Asian=19%, NHW=32%). Moreover, the net burden of comorbidities (CCI=3+) was higher among NHB women compared with other racial and ethnic groups (NHB=22% vs non-Hispanic Asian=9%, Hispanic=13%, NHW=13%). In the multivariable-adjusted models, ovarian cancer patients with diabetes (HR=1.16, 95%CI 1.03, 1.31), cardiovascular disease (HR=1.32, 95% CI 1.22, 1.44), hypertension (HR=1.07, 95%CI 0.99, 1.16), or renal disease (HR=1.25, 95%CI, 1.14, 1.38 at the time of their diagnosis were more likely to die than those without the corresponding comorbidity. NHB ovarian cancer patients had an increased hazard of mortality across nearly all comorbid conditions compared with NHW patients, whereas Hispanic women had equivalent mortality rates as NHW patients, and non-Hispanic Asian patients had reduced mortality rates compared with NHW patients across each individual comorbidity. Conclusions: These analyses indicate that the presence of comorbid conditions negatively impacts survival among ovarian cancer patients. Moreover, NHB ovarian cancer patients are more likely to present with comorbidities at the time of their ovarian cancer diagnosis compared with other racial and ethnic groups, which may partially explain the observed disparities.
Citation Format: Lindsay J. Collin, Jia Li, Valerie S. Lee, Juraj Kavecansky, Christine Garcia, Carola Sanchez Diaz, Scarlett Lin Gomez, Jennifer A. Doherty, Elisa V. Bandera, Lawrence H. Kushi. Contribution of comorbid conditions to racial and ethnic disparities in ovarian cancer survival [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B102.