Background: Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. Methods: We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. Results: The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. Conclusions: First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen.
背景：在健康研究中，剥夺指数常被用于调整社会经济差异的影响。这些指数在某些人群层面的癌症结局评估中已得到部分验证，但对其在卵巢癌中的作用研究仍有限。本研究在一组自述为黑人且确诊卵巢癌的女性队列中，评估了一系列公认的剥夺指数与癌症生存期的关联。本研究旨在探究，在卵巢癌生存率较低的少数族裔群体中，临床或诊断特征是否在社会经济地位（SES）、剥夺指数与卵巢癌生存期之间起中介作用。 方法：我们采用中介分析方法，以诊断时的SEER分期和残留病灶为主要中介变量，考察剥夺指数的直接与间接因果效应。分析采用贝叶斯结构方程模型进行变量选择，并构建了中介变量的联合贝叶斯结构模型，其中生存结局采用以剥夺指数为暴露因素的威布尔混合模型。通过蒙特卡洛模型选择程序筛选修正变量。 结果：研究表明，高社会经济地位相关指数（如Yost指数、Kolak城市化指数、流动性指数、社会经济地位维度指数及集中劣势指数）均对改善生存期有显著影响。相比之下，地区剥夺指数和地区贫困水平指数未表现出主要影响。在某些情况下，间接效应的可信区间较宽，因此尽管直接效应可估计，总效应仍难以准确评估。 结论：首先，常用指数如Yost指数和集中劣势指数均显著影响确诊上皮性卵巢癌的黑人女性生存状况。此外，Kolak维度指数（城市化、流动性、混合移民指数及社会经济地位）也根据所选中介变量的不同表现出显著关联。中介效应因所选中介变量的差异而有所不同。
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