Socioeconomic disparities between oral cavity cancer patients in Germany

Abstract

ObjectiveIn many countries the access to high quality medical service depends on socioeconomic factors. Therefore, these factors are associated with the treatment and prognosis of many diseases. In Germany health care is claimed to be independent from such factors due to obligatory health insurance and a well-developed medical infrastructure. Thus, socioeconomically caused health disparities should be absent. The aim of this study was to analyze the association between socioeconomic factors and the survival of oral cavity cancer in Germany.Patients and methodsIn this descriptive cohort study socioeconomic status related factors as well as demographic, tumor-specific, and comorbidity factors of 500 patients treated for oral cavity cancer were obtained in the university hospital of Dresden. Pearson correlation was used to describe associations between continuous variables. Associations between categorical variables were assessed using the chi-square test. Overall and recurrence-free survival were studied using the Kaplan-Meier method. Log-rank test was carried out to test between-group differences. Cox proportional hazard models were used to estimate the risk of death and the risk of recurrence.ResultsSignificant differences in overall survival were found between the different educational levels and sex. Seventy-nine percent of the patients did not have a university degree or master craftsman/craftswoman. Less discrepancy was observed according to the marital status (49.4% married/engaged vs. 47.8% single, divorced, or widowed). In the multivariable analysis only sex, age at diagnosis, the Charlson score, the number of positive lymph nodes, and the nodal status were identified as independent predictors for overall survival whereas sex and the age at diagnosis were identified as independent predictors for recurrence-free survival.ConclusionDespite the equitable health system in Germany, significant associations between overall survival of oral cavity cancer and different socioeconomic factors could be found. For elimination of these disparities, health education programs should be established in socially deprived areas. Furthermore, clinicians should keep these factors in mind when determining recall periods for dental check-ups.

A scoping review of the additive manufacturing of mandibular implants

“…One of the benefits of CPC is its injectability; it can be manufactured using 3D printing. Muallah et al (2021) investigated the mechanical properties and cell migration of 3D-printed CPC cubes with varying pore sizes and printing orientations compared to commercially available bone substitutes. According to the findings, scaffolds should be printed with a pore size of 490 m for locations subjected to high pressure, and scaffolds should be printed with a pore size of 750 m for non-high-pressure areas.…”

An overview of the burden of oral cancer in Sri Lanka and its inequalities in the face of contemporary economic and social malaise

“…Area based deprivation indicators are not available for Sri Lanka similar to high income countries. Those countries have assessed the magnitude of social inequalities in oral cancers and outcomes using area‐based indicators 7,19–22 . We used poverty head count ratios stipulated by the Department of Census and Statistics for the year 2019 36 .…”

“…Nevertheless, there is a large amount of research that supports ethnic/racial, gender and social inequalities in oral cancer in many countries across the world 7,10,19–22 . As suggested by some studies, socio‐economic status has been a driver for racial disparities in some types of head and neck cancers 46 .…”

“…Those countries have assessed the magnitude of social inequalities in oral cancers and outcomes using area-based indicators. 7,[19][20][21][22] We used poverty head count ratios stipulated by the Department of Census and Statistics for the year 2019. 36 These were based on the updated national poverty line for Sri Lanka.…”

“…Assessing social inequalities in incidence of oral cancer and its trends has garnered much attention from researchers, particularly from developed countries, 7,14,[19][20][21][22] yet the disparities could be even wider in LMICs and LICs. Most LMICs and LICs with a high burden of oral cancer are not measuring or monitoring social inequalities in health at the national or regional levels.…”