Evaluating the Interplay of Structural, Social, and Spatial Factors in Ovarian Cancer Survival Disparities in California

About This Grant

PROJECT SUMMARY This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in epidemiology at UCSF, with the training necessary to become a researcher in cancer health disparities. Her training goals for this fellowship are to gain expertise in translational research, geospatial data analysis, and causal inference methods under the guidance of a team of expert mentors. This fellowship will provide the applicant with the skills, content knowledge, and practical experience to launch an independent research career in social epidemiology, focusing on translational research on cancer health disparities. Ovarian cancer is a significant cause of cancer-related deaths among women in the United States, with heterogeneous survival rates across racial and ethnic groups. Considerable health disparities in ovarian cancer outcomes are observed by race and ethnicity, socioeconomic status, and other factors, and are driven by multilevel causes from structural and historical societal processes to risk behaviors and biologic processes. Access to cancer specialists, including spatial accessibility, is essential for improved ovarian cancer outcomes. Addressing limitations of previous research, the proposed study will utilize novel comprehensive measures of spatial medical accessibility and causal inference framework to evaluate the interplay of structural, social, and spatial factors in ovarian cancer survival disparities in California. Building on prior work of the trainee, this F31 uses the data from the statewide population-based California Cancer Registry and publicly available spatial and contextual datasets to: (Aim 1) identify structural and social factors (residential economic and racial and ethnic segregation, racial and ethnic composition, neighborhood socioeconomic status, rurality, and transit access) associated with spatial accessibility of gynecologic oncologists in California; (Aim 2) quantify the extent to which the disparities in ovarian cancer survival in California, that are driven by structural and social factors, are mediated by spatial accessibility of gynecologic oncologists. This evidence will inform policies to increase equitable access to ovarian cancer care and narrow disparities. Knowledge gained from this research will advance the goals of the NCI’s National Cancer Plan to eliminate inequities, deliver optimal care, and maximize data utility. The major strengths of this proposal are 1) the use of population-based California Cancer Registry data with which the applicant has experience working and which represents a region with a diverse landscape, local economies, and racial and ethnic composition; 2) the use of the state-of-the-art geospatial method for the development of the individual-level spatial medical accessibility measure; 3) the application of multilevel health disparities framework and rigorous causal inference methods for studying modifiable contributors of ovarian cancer disparities. The interdisciplinary training environment and the expert mentorship team will provide the applicant with an excellent training opportunity to develop methodological and content expertise for a future career as an independent researcher of cancer health disparities.