Impact of community disadvantage and air pollution burden on geographic disparities of ovarian cancer survival in California

Abstract

Ovarian cancer survival varies geographically throughout California. The objective of this study is to determine the impact of living in disadvantaged communities on spatial patterns of survival disparities. Including a bivariate spatial smooth of geographic location within the Cox proportional hazard models is an effective approach for spatial analyses of cancer survival. Women diagnosed with advanced Stage IIIC/IV epithelial ovarian cancer (1996–2006) were identified from the California Cancer Registry. The impact of living in disadvantaged communities, as measured by the California Office of Environmental Health Hazard Assessment cumulative CalEnviroScreen 2.0 score, on geographic disparities in survival was assessed while controlling for age, tumor characteristics, quality of care, and race. Community-level air quality indicators and socioeconomic status (SES) were also independently examined in secondary analyses. The Cox proportional hazard spatial methods are available in the MapGAM package implemented in R. An increase in the community disadvantage from the 5th (less disadvantage) to the 95th percentile (more disadvantage) was significantly associated with poorer ovarian cancer survival (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.07–1.26). Ozone levels and SES were the most influential indicators on geographic disparities that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential air quality-related predictors of geographic disparities.

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

“…CalEnviroScreen is noteworthy in this regard. Researchers used CalEnviroScreen to model ovarian cancer survival rates [ 44 ], predict spatial patterns in disease burden [ 45 ], evaluate electrical grid siting alternatives [ 46 ], and corroborate environmental racism and cumulative impact claims by community members opposing the siting of a new hazardous waste facility in their community [ 47 ]. In addition, CalEnviroScreen is the only screening tool among these four with statewide coverage, and it is meant to assist the State of California in locating the most environmentally burdened, “disadvantaged communities,” for the targeted receipt of a quarter of the Greenhouse Gas Reduction Funds obtained through California’s carbon cap-and-trade program [ 33 ].…”

Comparison of Ground-Based PM2.5 and PM10 Concentrations in China, India, and the U.S.

“…In recent years, there has been relatively little particulate contamination in the U.S. [ 27 ]. Thus, research in this area has been relatively scarce and the current studies mainly focus on areas where PM pollution continues to be relatively high, such as California [ 28 ] and Arizona [ 29 ]. However, as these studies were mainly concentrated in megacities, the results are fragmented and it is difficult to understand these trends from a macroscopic perspective.…”

A multivariate analysis of CalEnviroScreen: comparing environmental and socioeconomic stressors versus chronic disease

“…This was similar to Gaffron and Niemeier [ 19 ], who observed a very low bivariate strength of association (R 2 = 0.018) between PM 2.5 (environmental variable) and emergency visits for asthma (health outcome) employing CalEnviroScreen census tract data in six Sacramento, CA region counties. Especially, studies are needed combining longitudinal data sets of disease occurrence with CalEnviroScreen and other hazard measures [ 30 ].…”

“…Previous studies at similar spatial scales and resolutions have established relationships of environmental hazards and disease risk with race and socioeconomic status, with implications for resource allocation and policy [ 14 , 15 , 19 , 24 , 60 ]. Prior studies have also shown geographic indicators of socioeconomic status or vulnerability to be associated with hospitalization rates or disease occurrence [ 2 , 30 ]. However, few studies explicitly evaluate and describe the multiple patterns of association that occur across a range of health hazards and vulnerabilities at the census-tract scale [ 9 , 10 ].…”

“…The methodology for developing CalEnviroScreen has been detailed elsewhere, and CalEnviroScreen has previously been shown by the scientific development team to indicate strong racial disparities in environmental and socioeconomic vulnerability [ 23 , 24 ]. The method and some of the underlying assumptions have also been subject to scrutiny as part of a public review process [ 21 , 29 ], and a previous iteration (CalEnviroScreen version 2.0) was employed as a community disadvantage indicator, and found to be significantly associated with ovarian cancer survival [ 30 ]. Despite these applications and their policy significance, an October 10, 2017 search of all peer reviewed journal publications in Google Scholar and in PubMed that include the term “CalEnviroScreen” revealed no independent evaluation of CalEnviroScreen in the peer reviewed scientific literature.…”