The Intersectionality between Race, Ethnicity, and Residential-Level Socioeconomic Status in Disparities of Head and Neck Cancer Outcomes: A SEER Study

Abstract

Background Head and Neck cancer (HNC) mortality differs by race, ethnicity, and socioeconomic status (SES). However, it is unclear whether the relationship between race/ethnicity and HNC-specific mortality varies according to the residence-level SES. Methods: Data from the Surveillance, Epidemiology, and End Results database included participants with primary HNC between 2006-2017 (followed through 2018) to assess the joint association of race/ethnicity and census-tract level SES Yost-index groups (quintiles) with all-cause and HNC-specific mortalities. Relative survival rates at one/five/ten years were calculated. Multivariable Cox proportional hazard regression models estimated hazard-ratios and 95% confidence intervals for all-cause mortality, and Fine-Gray subdistribution hazard models for HNC-specific mortality. Cumulative incidence curves for HNC-specific deaths were estimated. Results 76,095 patients were included in the analysis: 63.2% were <65 years, 73.4% male, and 11.3% non-Hispanic (NH) Black. Most patients (58.3%) were diagnosed at regional or distant stages and 20.6% died of HNC. The five-year relative survival rate increased with SES group, with 51.6% in the lowest SES group, and 74.1% in the highest SES group. NH-Black patients had higher risk of all-cause and HNC-specific mortality than NH-White patients, regardless of the SES group. NH-Asian/Pacific Islander and Hispanic patients had higher risk of HNC-specific mortality in some SES groups. Conclusions NH-Black patients of all SES strata had significantly worse outcomes. Other factors, such as healthcare quality, may be associated with persistent disparities.

The prognostic role of cigarette smoking in oral cavity and pharyngeal cancer survival

“…The Hispanic Paradox suggests that Hispanics tend to have superior outcomes when compared to their white adult counterparts 34 despite their lower SES, but previous studies evaluating race/ethnicity in cancer outcomes have found no such evidence of this paradox. 35,36 In agreement with previous reports 33 , Black adults had a worse prognosis in multivariate analyses. Despite adjusting for stage at diagnosis, both the no surgery and no radiation groups fared worse, suggesting another factor is affecting prognosis than purely advanced stage.…”

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

“…In this study, patients residing in areas with persistent poverty were more likely to be Black, from rural counties, and less likely to receive surgical resection compared to their counterparts in non-persistent poverty. Prior research studies have identi ed differences by race, SES, insurance status, income, distance to care, hospital volume, and facility type (4,(27)(28)(29)(30)(31)(32), this study adds persistent poverty to the list of factors that affect the diagnosis and outcomes of OPC. These results are consistent with Moss et al previous work that examined the association of persistent poverty and all cancer sites and additionally by speci c cancer sites with high mortality burden.…”

“…In the year 2023, it is projected that an estimated 54,540 individuals will be diagnosed with oral cavity and pharyngeal cancers (OPC) in the United States, accounting for 2.8% of all newly diagnosed cancer cases (1). Despite an overall 5-year survival rate of ~ 68% for OPC, persistent disparities exist that adversely affect survival rates among disadvantaged groups, speci cally individuals belonging to lower socioeconomic status (SES) (2)(3)(4). Among the various measures of SES, neighborhood poverty or regional deprivation has been recognized as an important predictor of unfavorable OPC outcomes (2,3).…”