Assessing the Socio-geographic and lifestyle Factors Impacting Epithelial Ovarian Cancer Outcomes: A Retrospective Study Based on County Health Ranking in Missouri
Abstract
Objective
This study examined how obesity, smoking, and pregnancy history, characterized as lifestyle factors, are associated with survival of epithelial ovarian cancer, and investigated whether epithelial ovarian cancer presentation, survival, and cancer recurrence are affected by patient home geographic location.
Methods
A retrospective analysis was conducted on all patients with epithelial ovarian cancer treated at the University of Missouri and Ellis Fischel Cancer Center between 2008 and 2023. Patient charts were reviewed for cancer history, lifestyle factors, patient status, laboratory values, and residential zip codes which were categorized using Missouri ZIP Health Rankings. Survival, cox univariate and multivariate logistic regression, and association analyses were performed.
Results
In this cohort, stage at diagnosis, histologic type, age at diagnosis and initial CA125 proved to be significant predictors of survival, while lifestyle factors including BMI, smoking, and pregnancy were not. Notably, patients residing in communities with the lowest zip code health rankings experienced higher rates of cancer recurrence, despite a lower overall number of cases compared to higher-ranked communities.
Conclusion
Although the lifestyle factors investigated in this study were not significantly associated with survival, a geographic disparity in recurrence rates and total cases was clear, suggesting possible underdiagnosis and barriers to accessing care in lower ranked zip codes. These findings emphasize an evident need to further investigate community-specific healthcare access and delivery, as well as other lifestyle factors that may be contributing to these differences.
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