Persistent Poverty Disparities in Incidence and Outcomes Among Oral and Pharynx Cancer Patients

Abstract

Purpose Disparities in oral cavity and pharyngeal cancer (OPC) based on race/ethnicity and socioeconomic status have been reported, but the impact of living within areas that are persistently poor at the time of OPC diagnosis and outcome is unknown. This study aimed to investigate whether the incidence, 5-year relative survival, stage at diagnosis, and mortality among patients with OPC varied by persistent poverty. Methods Data was drawn from the SEER database (2006-2017) and included individuals diagnosed with OPC. Persistent poverty (at census tract) is defined as areas in which ≥20% of the population lived below the poverty level for ~30 years.Age-adjusted incidence and 5-year survival rates were calculated. Multivariable logistic regression was used to estimate the association between persistent poverty and advanced stage. Cumulative incidence and multivariable subdistribution hazard models were used to evaluate mortality risk. Additionally, results were stratified by cancer primary site, sex, race/ethnicity, and rurality. Results Of the 90,631 patients included in the analysis (61.7% <65 years old, 71.6 % males) 8.8% lived in persistent poverty. Compared to non-persistent poverty, patients in persistent poverty had higher incidence and lower 5-year survival rates. Throughout 10 years, the cumulative incidence of cancer death was greater in patients from persistent poverty and were more likely to have advanced stage cancer and higher mortality risk. In the stratified analysis by primary site, patients in persistent poverty with oropharyngeal, oral cavity, and nasopharyngeal cancers had an increased risk of mortality compared to the patients in non-persistent poverty. Conclusion This study found an association between OPC outcomes among patients in persistent poverty indicating a multidimensional strategy to improve survival.