Objectives Black and Hispanic ovarian cancer (OC) patients are less likely to receive guideline-adherent and timely cancer care. We aimed to evaluate the associations between healthcare affordability (HA) and receipt of high-quality surgery and time to surgery among OC patients by race.

Methods Data from the 2016 NCDB on Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic OC patients diagnosed in 2004–2016 was analyzed. Measures of HA included area-level income and insurance status. Multinomial logistic regression was used to estimate the odds of receiving high-quality surgery compared with low-quality or no surgery. Multivariable linear regression was used to analyze differences in time, in days, from diagnosis to surgery.

Results The cohort included 113,702 patients: 86% NHW, 8% NHB and 6% Hispanic. Compared to private insurance, uninsured and Medicaid patients were more likely to receive no surgery (uninsured: aOR 2.55; 95% CI 2.28–2.85 and Medicaid: aOR 2.05; 95% CI 1.86–2.26). Lower income patients were more likely to receive low-quality surgery (aOR 1.20; 95% CI 1.13–1.27) or no surgery (aOR 1.42; 95% CI 1.31–1.53) relative to higher income patients. These associations were strongest among uninsured Hispanic and lowest income NHB patients. Relative to private insurance, Medicaid patients were more likely to have longer time to surgery (b 6.09; 95% CI 4.17–8.02). This association was strongest among NHB and Hispanic Medicaid patients.

Conclusions Low healthcare affordability is associated with lack of high-quality and timely surgery especially among NHB and Hispanic patients, indicating the need for interventions promoting equitable access to guideline-adherent care for all OC patients.