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

Andrew B. Lawson, Joanne Kim, Courtney Johnson, Theresa Hastert, Elisa V. Bandera, Anthony J. Alberg, Paul Terry, Maxwell Akonde, Hannah Mandle, Michele L. Cote, Melissa Bondy, Jeffrey Marks, Lauren Peres, Kendra L. Ratnapradipa, Yao Xin, Joellen Schildkraut, Edward S. Peters

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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 diagnosed 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 increased 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.

Original languageEnglish (US)
Pages (from-to)57-64
Number of pages8
JournalAnnals of Epidemiology
StatePublished - Oct 2023


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

ASJC Scopus subject areas

  • Epidemiology


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