Measures of economic advantage associated with HPV-positive head and neck cancers among non-Hispanic black and white males identified through the National Cancer Database

Abstract

Background National trends show dramatic increases in the incidence of HPV-related head and neck squamous cell carcinomas (HNSCCs) among black and white males. Using cases identified through the National Cancer Data Base, we assessed factors associated with HPV 16- or 16/18 positive HNSCCs among non-Hispanic black and white males diagnosed in the U.S. between 2009 and 2013. Methods This sample included 21,524 HNSCCs with known HPV status. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression. Results Compared to those with HPV-negative tumors, male patients diagnosed with HPV-positive HNSCCs were non-Hispanic white, younger at diagnosis, lived in zip-code areas with higher median household income and higher educational attainment, had private health insurance and no reported comorbidities at diagnosis. Although the risk of HPV-positive HNSCCs increased with measures of higher area-level socioeconomic status, the effect was stronger for non-Hispanic black males (RRAdjusted = 1.76, 95% CI 1.49–2.09) than for whites (RRAdjusted = 1.12, 95% CI 1.08–1.16). The peak age for diagnosis of HPV-positive HNSCCs occurred in those diagnosed at 45–49 years (RRAdjusted = 1.57, 95% CI 1.42–1.73). Oropharyngeal tumors were strongly associated with HPV-positivity (RRAdjusted = 4.32, 95% CI 4.03–4.63). In the analysis restricted to oropharyngeal anatomic sites, similar patterns persisted. Conclusion In our analysis, measures of economic advantage were associated with an increased risk of HPV-positive HNSCCs. In order to develop effective interventions, greater understanding of the risk factors for HPV-positive HNSCCs is needed among both high-risk males and their healthcare providers.

Socioeconomic status, access to care, risk factor patterns, and stage at diagnosis for head and neck cancer among black and white patients

“…Furthermore, a previous analysis of CHANCE data showed stronger behavioral risk factor (tobacco and alcohol use) associations in lower SES patients 16 but did not include the analysis of access to care or associations with stage. Annual dental exams have also been shown to be associated with early‐stage disease in a CHANCE study, 41 and HPV‐positive oropharyngeal cancer has been associated with high SES in studies of other U.S. cohorts 46,47 . Overall, our current results are similar to those of other studies, but our integrative analysis has added to the understanding of HNSCC‐associated factors by providing a more comprehensive overview that shows an association of SES, access to care, and other risk factors in combination within latent classes rather than as individual contributing components.…”

JAK3 Variant, Immune Signatures, DNA Methylation, and Social Determinants Linked to Survival Racial Disparities in Head and Neck Cancer Patients

“…HNSCC disparities are partly mediated by differences in access to care, stage at diagnosis, insurance status, attitudes of health providers, as well as HPV infection status (70,71) and measures of economic advantage (72). Variations in tumor-associated immune responses between Black and NLWs have also been implicated in cancer health disparities (73)(74).…”

“…Molecular alterations linked to HNSCC survival, such as TP53 mutations (75), loss of heterozygosity (28), microsatellite instability (29), and differential DNA methylation (30) have been associated to HNSCC main risks factors: tobacco smoking, alcohol consumption, and HPV status (31). Most HPV þ tumors occur in the oropharynx, show superior responses to chemotherapy and radiotherapy (32)(33)(34), and are less prevalent in Black patients with HNSCC (36,72). They are also characterized by TILs of the stroma and tumor nests, suggesting HPV þ HNSCC tumors do not evade immune surveillance (76).…”

Exposure to Evidence of White Privilege and Perceptions of Hardships Among White UK Residents

“…There has been growing attention to the antecedents of racist attitudes among ethnic majority groups, most notably white individuals and groups (Biernat and Crandall 1999;Dovidio and Gaertner 1986;Kluegel and Smith 1982;Stephan and Stephan 2000); as white people have both in the past (Farley and Allen 1987;Killian 1990;Sidanius and Pratto 1999) and present (Brooks 2015;Lerman 2017;Peterson et al 2017) been at an advantage over Black, Asian and Minority Ethnic (BAME) individuals on indicators of both wealth and social status. White privilege has been defined as the 'unearned benefits and advantages' that are handed out to white people as a result of a system that is 'normed and standardized on White-European values, with most of the structures, policies and practices of the institutions being situated in such a manner as to pave the road for white individuals while creating obstacles for other groups' (Sue 2003, p. 138).…”