"Black women have a 10% lower 5-year survival of epithelial ovarian cancer (EOC) than White women, despite having a 25% lower incidence of OC than White women. Evidence suggests that these health disparities can be partially explained by neighborhood social and environmental factors such as disorder. We used Google Street View (GSV) imagery to estimate a measure of neighborhood disorder (ND) at the block group level within the largest multi-state cohort study of Black women diagnosed with EOC (AACES) between 2010 and 2015. 592 AACES participants were enrolled and geocoded residing in 544 unique block groups. We used the online Computer Assisted Neighborhood Visual Assessment System (CANVAS), to conduct virtual audits at 5 street address locations in each block group. These audits included questions related to the presence of different types of land use, the quality of the built structures, and the presence of other markers of ND. Factor analysis identified 5 distinct neighborhood factors: developmental intensity, development age, neighborhood disorder, land use, and green/blue space. An ND score was calculated for each block group audited based on the ND factor, which included the condition of residential units and yards, and assigned to the residents of that block group. Initial analyses indicated that this score did not impact EOC survival. We conducted Weibull AFT survival analyses with frailty to assess the impact of racial segregation on the relationship between ND and EOC survival. An Isolation Index was calculated to quantify the segregation of non-Hispanic Blacks compared to other racial groups. Increased racial isolation was associated with decreased survival (HR: 1.234, 95%CI: 1.03-1.60), after adjustment. Additionally, to understand the impact of the social aspects of disadvantage compared to the built aspects of our disorder score, we examined ADI as a predictor of EOC survival. Increasing ADI was associated with marginally decreased survival (HR: 1.002, 95%CI: 1.00-1.01), after adjustment. The lack of association between our disorder score and EOC survival and the presence of an association between the measures of racial isolation and ADI and EOC survival could indicate that it is the social aspects of an environment, not the built factors, that are driving EOC survival. Future research should explore the impacts of racial segregation and individual-level perceived racism on EOC survival."
