Geographic accessibility to obstetricians and gynecologists is associated with incidence of live birth among Black adolescent and young adult female cancer survivors in Texas

Abstract Objective: To assess incidence of live birth after cancer diagnosis among Black adolescent and young adult women (AYA) age 15-39 years at diagnosis, and evaluate whether incidence varies by exposure to racial residential segregation, neighborhood poverty, or geographic accessibility to obstetricians/gynecologists. Methods: Black AYA women diagnosed with cancer between January 1, 1995 and December 31, 2015 were identified using population-based data from the Texas Cancer Registry. These data were linked with live birth certificates through December 31, 2016 to identify the first live birth after diagnosis. We measured three neighborhood characteristics using the 2010 U.S. Census: 1) Black racial residential segregation, using the Index at the Concentration of Extremes; 2) percent of the population living in poverty; and 3) geographic accessibility to obstetricians/gynecologists, calculated using National Provider Identifier data as the supply of healthcare and U.S. Census data as the demand for healthcare. We estimated cumulative incidence of live birth accounting for the competing risk of death, overall and by low vs. high (≥ 20%) poverty and sample-based quartiles of racial residential segregation and geographic accessibility. Results: We identified 689 first live births to 7,921 Black AYA women after cancer diagnosis. Two-thirds of the sample were age 30 years or older at diagnosis: 27.3% were aged 30-34 and 45.6% were aged 35-39. The most common cancer types were breast (34.3%), gynecologic (16.4%), lymphoma (9.8%), thyroid (8.5%), and gastrointestinal (7.5%). Stage at diagnosis was as follows: local (39.6%), regional (27.8%), distant (19.3%), and missing (13.4%). Five- and ten- year cumulative incidence of live birth after cancer diagnosis was 6.3 (95% confidence interval [CI]: 5.8-6.9) and 9.1 (95% CI: 8.4-9.8), respectively. Incidence of live birth was not associated with racial residential segregation or neighborhood poverty. Cumulative incidence of live birth varied by geographic accessibility to obstetricians/gynecologists (p=.046); however, nonlinear patterns were observed starting around five years after diagnosis, such that those residing in quartiles 1 (lowest accessibility) and 3 had lower incidence of live birth compared to those in quartiles 2 and 4 (highest accessibility). Discussion: To our knowledge, this is the first study examining the association of neighborhood characteristics and incidence of live birth in a population-based sample of Black AYA women after cancer diagnosis. We did not observe associations for racial residential segregation or neighborhood poverty. This may indicate that characteristics such as current health status, types of treatment received, or treatment side effects are more relevant for live birth after diagnosis. Geographic accessibility to obstetricians/gynecologists was associated with live birth, but in a nonlinear fashion. Future analyses will assess spatial patterns and potential confounders, such as urban or rural residence, which may account for non-linearity in this association. Citation Format: Sandi L. Pruitt, Jennifer S. Wang, Kevin A. Henry, Lynn N. Ibekwe, Caitlin C. Murphy. Geographic accessibility to obstetricians and gynecologists is associated with incidence of live birth among Black adolescent and young adult female cancer survivors in Texas [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B094.