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Wilson CA, Jamil TL, Velu PS, Levi JR. Patient Factors Associated with Missed Otolaryngology Appointments at an Urban Safety-Net Hospital. Laryngoscope 2024; 134:4003-4010. [PMID: 38602281 DOI: 10.1002/lary.31401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment. METHODS This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors. RESULTS Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant. CONCLUSION A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC. LEVEL OF EVIDENCE IV Laryngoscope, 134:4003-4010, 2024.
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Affiliation(s)
- Carolyn A Wilson
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Taylor L Jamil
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University School of Public Health, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Preetha S Velu
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A
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Whitehead RA, Patel EA, Liu JC, Bhayani MK. Racial Disparities in Head and Neck Cancer: It's Not Just About Access. Otolaryngol Head Neck Surg 2024; 170:1032-1044. [PMID: 38258967 DOI: 10.1002/ohn.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC. DATA SOURCES A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications. REVIEW METHODS Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent. RESULTS Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes. CONCLUSION Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.
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Affiliation(s)
- Russell A Whitehead
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mihir K Bhayani
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Wang AW, Patel EA, Patel N, Poulson TA, Jagasia AA. Otolaryngology Care Disparities in American Indian Populations. OTO Open 2024; 8:e124. [PMID: 38495073 PMCID: PMC10941493 DOI: 10.1002/oto2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Our objectives were to quantify geographical disparities in otolaryngology care access with respect to American Indian (AI) populations and to identify gaps in care. Although increased incidence and mortality rates of ear, nose, and throat (ENT) conditions in AI populations are well documented, few studies address factors contributing to these differential outcomes. We conducted a cross-sectional study of US states with AI areas that either met the population threshold for the American Community Survey annual estimate or annual supplemental estimate. A 2-tailed t test was used to compare the geographic distribution of ENT providers practicing within AI areas against non-AI areas, showing a statistically significant difference (P < .001) in the concentration of providers (0.409 vs 2.233 providers per 100,000 patients). To our knowledge, this is the first study to explore geographic barriers contributing to AI disparities within otolaryngology.
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Affiliation(s)
- Alan W. Wang
- Chicago Medical SchoolRosalind Franklin UniversityNorth ChicagoIllinoisUSA
| | - Evan A. Patel
- Department of Otolaryngology–Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Nina Patel
- Department of Otolaryngology–Head and Neck SurgeryLoyola University Stritch School of MedicineMaywoodIllinoisUSA
| | - Trevor A. Poulson
- Department of Otolaryngology–Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Ashok A. Jagasia
- Department of Otolaryngology–Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
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Clausyl Plummer II, Mensah C, Kline-Quiroz C. Disparities of health impacting head and neck cancer and rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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5
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Zheng M, Zhou S, Hur K, Chambers T, O'Dell K, Johns M. Disparities in the prevalence of self-reported dysphagia and treatment among U.S. adults. Am J Otolaryngol 2023; 44:103774. [PMID: 36586319 DOI: 10.1016/j.amjoto.2022.103774] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess sociodemographic differences in the prevalence of self-reported dysphagia and treatment and to identify barriers in access to care. STUDY DESIGN Cross-sectional analysis. SETTING National healthcare survey database. METHODS The 2012 National Health Interview Survey was used to analyze adults who reported a swallowing problem in the prior 12 months. Associations of sociodemographic variables with dysphagia prevalence and treatment as well as access to care were determined by multivariate logistic regression. RESULTS Among 235 million adults in the United States, 9.4 ± 0.3 million (4.0 % ± 0.1 %) adults (mean age 52.1 ± 0.6 years; 60.2 % female) reported swallowing problems, only 19.2 % ± 2.0 % of whom reported receiving treatment or therapy for their swallowing problem. In a multivariate model controlling for sociodemographic factors, female gender, older age, lower income level, public insurance status and unemployment were independently associated with increased odds of reporting dysphagia, while also associated with decreased odds of receiving treatment. Conversely, Black, Hispanic and other racial/ethnic minorities were less likely to report swallowing problems, but among those who did report dysphagia, non-white adults were more likely to receive treatment. Barriers leading to delayed care for women, low-income adults and adults with public or no health insurance included cost, not being able to get an appointment soon enough, limited office hours, inability to get through to an office by phone, lack of transportation, and long office wait times. CONCLUSION Sociodemographic groups at higher risk for dysphagia are less likely to receive treatment. Targeted interventions are needed to address barriers to care. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Melissa Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, SA, United States of America
| | - Sheng Zhou
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Kevin Hur
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Tamara Chambers
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Michael Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, United States of America.
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Nallani R, Subramanian TL, Ferguson-Square KM, Smith JB, White J, Chiu AG, Francis CL, Sykes KJ. A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research. Otolaryngol Head Neck Surg 2022; 166:1238-1248. [PMID: 35133913 DOI: 10.1177/01945998221077197] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri, USA
| | - Jacob White
- Research and Learning, A.R. Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie L Francis
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Warren BR, Grandis JR, Johnson DE, Villa A. Head and Neck Cancer among American Indian and Alaska Native Populations in California, 2009-2018. Cancers (Basel) 2021; 13:cancers13205195. [PMID: 34680342 PMCID: PMC8534223 DOI: 10.3390/cancers13205195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary In the United States, it is estimated there will be 54,000 new cases of oral cavity and pharyngeal cancer in 2021. Tobacco exposure and drinking alcohol are the main causes of head and neck cancer (HNC). Human Papilloma Virus (HPV) is now increasing in prevalence and is the most common cause of oropharyngeal cancer in the United States. This study assessed the incidence of HNC and HPV status in American Indian/Alaska Native (AI/AN) populations in California and determined if incidence was higher among AI/ANs compared to other ethnicities. We found that AI/AN and White patients had the highest burden of late-stage HNC and HPV+ lip, oral cavity, and pharynx cancer compared to other ethnicities. In addition, AI/ANs had a decreased survival rate compared to White patients. These findings reveal ethnic or racial differences in incidence, presentation, and survival, and should inform future preventative care measures for the AI/AN population. Abstract The purpose of this study was to determine the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) head and neck cancer (HNC) in the American Indian/Alaska Native (AI/AN) population in California to assess whether incidence is higher among AI/ANs compared to other ethnicities. We analyzed data from the California Cancer Registry, which contains data reported to the Cancer Surveillance Section of the Department of Public Health. A total of 51,289 HNC patients were identified for the years 2009–2018. Outcomes of interest included sex, stage at presentation, 5-year survival rate, tobacco use, and HPV status. AI/AN and White patients had the highest burden of late stage HNC (AI/AN 6.3:100,000; 95% CI 5.3–7.4, White 5.8:100,000; 95% CI 5.7–5.9) compared to all ethnicities or races (Black: 5.2; 95% CI 4.9–5.5; Asian/Pacific Islander: 3.2; 95% CI 3–3.3; and Hispanic: 3.1; 95% CI 3–3.2 per 100,000). Additionally, AI/AN and White patients had the highest burden of HPV+ lip, oral cavity, and pharynx HNC (AI/AN 0.9:100,000; 95% CI 0.6–1.4, White 1.1:100,000; 95% CI 1–1.1) compared to all ethnicities or races (Black: 0.8:100,000; 95% CI 0.7–0.9; Asian/Pacific Islander: 0.4; 95% CI 0.4–0.5; and Hispanic: 0.6; 95% CI 0.5–0.6). AI/ANs had a decreased 5-year survival rate compared to White patients (AI/AN 59.9%; 95% CI 51.9–67.0% and White 67.7%; 95% CI 67.00–68.50%) and a higher incidence of HNC in former and current tobacco users. These findings underscore the disparities that exist in HNC for California AI/AN populations. Future studies should aim to elucidate why the unequal burden of HNC outcomes exists, how to address increased tobacco usage, and HPV vaccination patterns to create culturally and community-based interventions.
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Affiliation(s)
- Brooke R. Warren
- School of Medicine, University of California, San Francisco, CA 94143, USA;
| | - Jennifer R. Grandis
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; (J.R.G.); (D.E.J.)
| | - Daniel E. Johnson
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; (J.R.G.); (D.E.J.)
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-476-2431
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8
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James J, Tsvik AM, Chung SY, Usseglio J, Gudis DA, Overdevest JB. Association between social determinants of health and olfactory function: a scoping review. Int Forum Allergy Rhinol 2021; 11:1472-1493. [PMID: 34047496 DOI: 10.1002/alr.22822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Social determinants of health (SDoH) include the socioeconomic, demographic, and social conditions that influence differences in health status among individuals and groups. The impact of these conditions on olfactory function remains poorly understood. In this scoping review, we systematically review the available literature to synthesize the association between SDoH and olfactory function. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines, we performed systematic search queries in PubMed, Embase, and Ovid databases and categorized articles according to themes that emerged regarding SDoH. The primary outcomes included self-reported and objective measurements of smell. RESULTS We identified 722 unique references that underwent title and abstract review by two independent reviewers, with 70 articles undergoing full-text review and 57 relevant for data extraction. Six themes emerged in our review, under which we categorized the studies and synthesized respective associations with olfactory function. These include studies exploring socioeconomic status (n = 19, 33%), education status (n = 27, 47%), occupational exposures (n = 26, 46%), racial/ethnic disparities (n = 12, 21%), and lifestyle/behavioral factors (n = 33, 58%). CONCLUSIONS Within the context of this scoping review, olfactory dysfunction is significantly more prevalent in patients with lower socioeconomic status, exposure to environmental and occupational toxins, and of minority race/ethnicity, whereas the associations between olfactory dysfunction and education level and lifestyle factors such as smoking and drinking seem to be much more elusive. This review highlights the importance of accounting for SDoH in observational studies examining olfactory outcomes. Given the increased awareness of olfactory loss, special consideration should be given to understanding olfactory dysfunction in the context of these factors.
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Affiliation(s)
- Joel James
- City University of New York School of Medicine, New York, NY
| | - Avraham M Tsvik
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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9
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Salous MH, Bind MA, Granger L, Johnson LB, Welch K, Villa A. An educational intervention on HPV knowledge and comfortability discussing vaccination among oral health care professionals of the American Indian and Alaskan Native population. Hum Vaccin Immunother 2020; 16:3131-3137. [PMID: 32401662 PMCID: PMC8641582 DOI: 10.1080/21645515.2020.1752595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023] Open
Abstract
This study aimed to evaluate the effectiveness of an educational intervention at improving Oral Health Professionals (OHP's) knowledge of HPV and comfortability to discuss vaccination with their American Indian and Alaskan Native patients. OHP's attended an educational lecture covering HPV vaccination. Participants completed four validated questionnaires that encompassed a sociodemographic survey, a pre-lecture questionnaire (pre-Q), a post-lecture questionnaire (post-Q), and a follow-up questionnaire (follow-Q). The McNemar test was used to assess the significance of marginal probabilities in the responses between the pre-Q and post-Q and the Chi-square test to assess responses between the post-Q and follow-Q. A total of 122 OHP's completed the sociodemographic survey, pre-Q, and post-Q. Among these, 29 OHP's completed the eight-week follow-Q. The majority of all the participants were White/Caucasian (41%), 31 to 60 years of age (72%), females (64%), and held a graduate/professional degree (52%). Analysis of the pre-Q responses showed that only 6.8% of OHP's discuss the connection between HPV and oropharyngeal cancer with patients and a lack of information on the topic was the major barrier reported. After the educational intervention (post-Q), 86.5% of OHP's reported they were more likely to recommend the HPV vaccine and 69.8% felt more comfortable administering it. Comparison between the pre-Q and the post-Q showed a significant improvement in overall HPV knowledge. Similarly, a comparison between the post-Q and the follow-Q showed retained knowledge overtime. Our study suggests that the educational intervention was effective at improving OHP's knowledge of HPV and enhancing their comfortability and preparedness to discuss the vaccination with their patients.
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Affiliation(s)
- Moaiad H. Salous
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA, USA
- Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Marie Abele Bind
- Department of Statistics, Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | - Louis Granger
- Department of Statistics, Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | - Lisa Bennett Johnson
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Kelly Welch
- Team Maureen, Dana-Farber Cancer Institute, North Falmouth, MA, USA
| | - Alessandro Villa
- Oral Medicine, Department of Orofacial Sciences, University of California, San Francisco, USA
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10
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Change in Age at Diagnosis of Oropharyngeal Cancer in the United States, 1975-2016. Cancers (Basel) 2020; 12:cancers12113191. [PMID: 33143031 PMCID: PMC7693134 DOI: 10.3390/cancers12113191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary While previous studies have suggested that HPV-associated head and neck cancer (HNC) is mostly in the younger population, we found that in the last 40 years, the mean age at diagnosis of oropharyngeal cancer has been 60.3 years. We found that after an initially decrease leading up to the early 2000s, there has been a steady increase in age at diagnosis of oropharyngeal cancer since 2002. For non-oropharyngeal HNC, mean age at diagnosis has steadily increased throughout the last four decades. Finally, we found that age at diagnosis of HNC is higher among females in general, and lowest among blacks. Abstract The emergence of the human papillomavirus (HPV) as the primary etiology of oropharyngeal cancer has changed head and neck cancer (HNC) epidemiology. This study described change in the age at diagnosis of oropharyngeal and non-oropharyngeal HNC in the United States in the last four decades. Using a retrospective cohort analysis, the Surveillance, Epidemiology, and End Results dataset from 1975 to 2016 was queried for eligible adult cases of HNC, grouped as oropharyngeal (n = 31,702) versus non-oropharyngeal (n = 87,108). Age at diagnosis was compared by gender (female, male) using independent t-test, and by race/ethnicity (Hispanic, non-Hispanic black, non-Hispanic white, non-Hispanic other) using analysis of variance. Joinpoint regression estimated yearly increases/decreases in age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Mean age at diagnosis for oropharyngeal cancer was 60.3 years. While there was initially a decrease in age at diagnosis, a 0.37% annual increase occurred from 2002 to 2016 (APC = 0.37, 95% confidence interval (CI) 0.28, 0.45). For non-oropharyngeal cancer, mean age at diagnosis was 63.2 years, with a continuous increase in age at diagnosis throughout the study period (1975–2016 AAPC = 0.08, 95% CI 0.04, 0.12). Females had higher average age at diagnosis than males for both sites, while blacks (57.4 years for oropharyngeal cancer; 59.0 years for non-oropharyngeal) had the lowest age at diagnosis of all races/ethnicity. Age at diagnosis of oropharyngeal cancer has increased significantly since 2002, while non-oropharyngeal HNC has increased significantly in the last four decades.
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11
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Pagedar NA, Davis AB, Sperry SM, Charlton ME, Lynch CF. Population analysis of socioeconomic status and otolaryngologist distribution on head and neck cancer outcomes. Head Neck 2018; 41:1046-1052. [PMID: 30549368 DOI: 10.1002/hed.25521] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/13/2018] [Accepted: 10/05/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The relationship between clinical outcomes and geographic determinants is not well known for head and neck cancer. Socioeconomic status (SES) factors and the distribution of health care resources might impact outcomes. METHODS Head and neck cancer cases in the Surveillance, Epidemiology, and End Results (SEER) database were studied. Patient-level prognostic factors were identified from the SEER, and county-level factors were identified from the Area Health Resource File. Stage at presentation and observed survival were the outcomes of interest, with predictive factors identified by multivariate logistic and Cox proportional hazards regression. RESULTS On multivariate analysis, tumor site, sex, race, marital status, rural residence, and county poverty level predicted stage at presentation. Sex, race, marital status, county-level poverty, and number of otolaryngologists predicted observed survival. CONCLUSION Adverse county-level SES predicted advanced cancer stage at presentation and diminished observed survival. SES was a stronger predictor of patient outcomes than rurality or number of otolaryngologists.
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Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Andrew B Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Steven M Sperry
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Mary E Charlton
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
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12
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Ghani WMN, Razak IA, Doss JG, Yang YH, Rahman ZAA, Ismail SM, Abraham MT, Wan Mustafa WM, Tay KK, Zain RB. Multi-ethnic variations in the practice of oral cancer risk habits in a developing country. Oral Dis 2018; 25:447-455. [DOI: 10.1111/odi.12995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/02/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Wan Maria Nabillah Ghani
- Oral Cancer Research and Coordinating Centre (OCRCC), Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - Ishak Abdul Razak
- Oral Cancer Research and Coordinating Centre (OCRCC), Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
- Faculty of Dentistry; MAHSA University; Selangor Malaysia
| | - Jennifer Geraldine Doss
- Oral Cancer Research and Coordinating Centre (OCRCC), Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - Yi-Hsin Yang
- School of Pharmacy; Kaohsiung Medical University; Kaohsiung City Taiwan
| | - Zainal Ariff Abdul Rahman
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - Siti Mazlipah Ismail
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - Mannil Thomas Abraham
- Oral Health Division, Ministry of Health; Federal Government Administrative Centre; Putrajaya Malaysia
| | | | - Keng Kiong Tay
- Oral Health Division, Ministry of Health; Federal Government Administrative Centre; Putrajaya Malaysia
| | - Rosnah Binti Zain
- Oral Cancer Research and Coordinating Centre (OCRCC), Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
- Faculty of Dentistry; MAHSA University; Selangor Malaysia
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13
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Challapalli SD, Simpson MC, Adjei Boakye E, Walker RJ, Antisdel JL, Ward GM, Osazuwa-Peters N. Survival differences in nasopharyngeal carcinoma among racial and ethnic minority groups in the United States: A retrospective cohort study. Clin Otolaryngol 2018; 44:14-20. [DOI: 10.1111/coa.13225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 09/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Matthew C. Simpson
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis Missouri
| | - Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research; St. Louis Missouri
| | - Ronald J. Walker
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis Missouri
| | - Jastin L. Antisdel
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis Missouri
| | - Greg M. Ward
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St. Louis Missouri
- Saint Louis University Cancer Center; St. Louis Missouri
- Department of Epidemiology; Saint Louis University College for Public Health and Social Justice; St. Louis Missouri
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14
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Bergmark RW, Hoehle LP, Chyou D, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Association of Socioeconomic Status, Race and Insurance Status with Chronic Rhinosinusitis Patient-Reported Outcome Measures. Otolaryngol Head Neck Surg 2017; 158:571-579. [PMID: 29256328 DOI: 10.1177/0194599817745269] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective Disparities in health and health care access are widely prevalent. However, disparities among patients with chronic rhinosinusitis (CRS) are poorly understood. We investigated if CRS severity at presentation according to socioeconomic factors. Study Design Cross-sectional study. Setting Tertiary rhinology center. Subjects and Methods Three hundred prospectively recruited patients presenting with CRS were included. Outcome variables included CRS symptomatology, as reflected by the 22-item Sinonasal Outcome Test (SNOT-22); general health status, as reflected by the EuroQol 5-dimensional visual analog scale (EQ-5D VAS); and CRS-related antibiotic and systemic corticosteroid use. Race/ethnicity, zip code income bracket, education level, and insurance status were used as predictor variables. Regression, controlling for clinical and demographic characteristics, was used to determine associations between predictor and outcome variables. Results Mean SNOT-22 score was 33.8 (SD, 23.2), and mean EQ-5D VAS score was 74.2 (SD, 18.9). On multivariable analysis, presenting SNOT-22 and EQ-5D VAS scores were not associated with nonwhite patient race/ethnicity ( P = .634 and P = .866), education ( P = .106 and P = .586), or the percentage of households in zip code with incomes <$50,000 per year ( P = .917 and P = .979, respectively). SNOT-22 scores did not differ by insurance type, but patients receiving Medicare reported worse general health status. Use of oral antibiotics or oral steroids for CRS was not associated with predictor variables. Conclusion Patients with CRS presented to a tertiary rhinology center with similar metrics for CRS severity and pre-presentation medical management regardless of race/ethnicity, education status, or zip code income level. Patients with Medicare had worse general health status. Further research should investigate potential disparities in diagnosis of CRS, specialist referral, and treatment outcomes.
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Affiliation(s)
- Regan W Bergmark
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lloyd P Hoehle
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Darius Chyou
- 2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Katie M Phillips
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - David S Caradonna
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,3 Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Stacey T Gray
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ahmad R Sedaghat
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,3 Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,4 Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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15
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Zhou AH, Chung SY, Patel VR, Unsal AA, Hsueh WD, Baredes S, Eloy JA. Do geographic differences or socioeconomic disparities affect survival in sinonasal squamous cell carcinoma? Int Forum Allergy Rhinol 2017; 7:1195-1200. [DOI: 10.1002/alr.22029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/19/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Albert H. Zhou
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Sei Y. Chung
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Varesh R. Patel
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Aykut A. Unsal
- Department of Otolaryngology and Facial Plastic Surgery; Rowan University School of Osteopathic Medicine; Stratford NJ
| | - Wayne D. Hsueh
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
- Department of Ophthalmology and Visual Science; Rutgers New Jersey Medical School; Newark NJ
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16
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Bergmark RW, Sedaghat AR. Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists. Laryngoscope Investig Otolaryngol 2017; 2:187-193. [PMID: 28894839 PMCID: PMC5562939 DOI: 10.1002/lio2.81] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 01/29/2023] Open
Abstract
Objectives Social determinants of health include social and demographic factors such as poverty, education status, race and ethnicity, gender, insurance status, and other factors that influence (1) development of illness, (2) ability to obtain and utilize healthcare, and (3) health and healthcare outcomes. In otolaryngology, as in other subspecialty surgical fields, we are constantly confronted by patients’ social and demographic circumstances including poverty, language barriers, and lack of health insurance and yet there is limited research on how these factors impact health equity in our field, or how attention to these patient characteristics may improve health equity. This review provides the reader with a framework to understand the social determinants of health including how socioeconomic status, insurance status, race, gender, and other factors impact health. Data Sources and Review Methods Foundational papers on the social determinants of health are reviewed, as well as otolaryngology publications focused on health and healthcare disparities. Results The social determinants of health have a major impact on patient health as well as healthcare utilization, but there is a relative lack of data on these factors and how they can be addressed within otolaryngology. Incorporating tools to measure social and demographic characteristics and actually report on these measures is a first simple step to increase the data on the social determinants of health as they pertain to otolaryngology. Conclusion More research is needed on the social determinants of health, and how they impact otolaryngic disease. Medicare's Accountable Care Organization models will increasingly change the way in which physicians are reimbursed, making the social determinants of health central not only to our moral conscience but also the bottom line. Level of Evidence 4
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Affiliation(s)
- Regan W. Bergmark
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A.
| | - Ahmad R. Sedaghat
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsU.S.A.
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17
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Dwojak S, Bhattacharyya N. Racial disparities in preventable risk factors for head and neck cancer. Laryngoscope 2017; 127:1068-1072. [PMID: 28215050 DOI: 10.1002/lary.26203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/18/2016] [Accepted: 06/27/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate racial differences in preventable risk behaviors/practices that contribute to head and neck cancer (HNCA). STUDY DESIGN Cross-sectional analysis of large national risk factor survey. METHODS The Behavioral Risk Factor Surveillance System for 2013 was analyzed. Demographic data were extracted, including age, sex, and race. Social habits considered risk factors for HNCA were also extracted, including alcohol consumption, smoking, and human papillomavirus (HPV) vaccination status. Statistical comparisons were conducted according to race for each risk factor, and additional comparisons were conducted within the American Indian population subgroup for risk factors according to sex. RESULTS A total of 238.6 million Americans were surveyed. American Indians reported higher rates of binge drinking (19.0%) than whites (17.3%), blacks (12.4%), and Asian Americans (13.1%; P < .001). This rate was significantly higher for American Indian males (23.5%) versus females (13.7%; P < .001). Mean total drinks per month was higher for whites and American Indians (13.5 and 13.5; P < .001). American Indians reported the highest rates of current smoking (28.1%), followed by blacks (20.1%), whites (18.3%), and Asians (10.2%; P < .001). American Indians also reported the highest rates of every day smoking (18.2%), versus whites (13.3%), blacks (13.1%), and Asians (6.1%; P < .001). Rates of HPV vaccination were lowest for American Indians (11.7%), compared to whites (14.6%), blacks (13.6%), and Asians (12%; P = 0.618). CONCLUSIONS There are striking racial disparities in the prevalence of preventable risk factors for HNCA. These data highlight the need for targeted education and prevention programs in particular racial groups. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1068-1072, 2017.
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Affiliation(s)
- Sunshine Dwojak
- Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Neil Bhattacharyya
- Harvard University, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
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18
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Withrow DR, Racey CS, Jamal S. A critical review of methods for assessing cancer survival disparities in indigenous population. Ann Epidemiol 2016; 26:579-591. [PMID: 27431064 DOI: 10.1016/j.annepidem.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE An increasing cancer burden among indigenous populations has led to a growing literature about survival disparities between indigenous and nonindigenous persons. We aim to describe and appraise methods used to measure cancer survival in indigenous persons in the United States, Canada, Australia, and New Zealand. METHODS We searched Medline, Web of Science, and EMBASE for articles published between 1990 and 2015 that estimated survival in populations indigenous to one of these four countries. We gathered information about data sources, analytical methods, and the extent to which threats to validity were discussed. RESULTS The search retrieved 83 articles. The most common approach to survival analysis was cause-specific survival (n = 49). Thirty-eight articles measured all-cause survival and 11 measured excess mortality attributable to cancer (relative survival). Three sources of information bias common to all studies (ethnic misclassification, incomplete case ascertainment, and incomplete death ascertainment) were acknowledged in a minority of articles. CONCLUSIONS The methodological considerations we present here are shared with studies of cancer survival across other subpopulations. We urge future researchers on this and related topics to clearly describe their data sources, to justify analytic choices, and to fully discuss the potential impact of those choices on the results and interpretation.
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Affiliation(s)
- Diana R Withrow
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada; Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - C Sarai Racey
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sehar Jamal
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada
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Dwojak S, Deschler D, Sargent M, Emerick K, Guadagnolo BA, Petereit D. Knowledge and screening of head and neck cancer among American Indians in South Dakota. Am J Public Health 2015; 105:1155-60. [PMID: 25320895 PMCID: PMC4431103 DOI: 10.2105/ajph.2014.302177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We established the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians in South Dakota and determined whether head and neck cancer screening detected clinical findings in this population. METHODS We used the European About Face survey. We added questions about human papillomavirus, a risk factor for head and neck cancer, and demographics. Surveys were administered at 2 public events in 2011. Participants could partake in a head and neck cancer screening at the time of survey administration. RESULTS Of the 205 American Indians who completed the survey, 114 participated in the screening. Mean head and neck cancer knowledge scores were 26 out of 44. Level of education was the only factor that predicted higher head and neck cancer knowledge (b = 0.90; P = .01). Nine (8%) people had positive head and neck cancer screening examination results. All abnormal clinical findings were in current or past smokers (P = .06). CONCLUSIONS There are gaps in American Indian knowledge of head and neck cancer risk factors and symptoms. Community-based head and neck cancer screening in this population is feasible and may be a way to identify early abnormal clinical findings in smokers.
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Affiliation(s)
- Sunshine Dwojak
- Sunshine Dwojak, Daniel Deschler, and Kevin Emerick are with the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Michele Sargent and Daniel Petereit are with the John T. Vucurevich Cancer Care Institute at Rapid City Regional Hospital, Rapid City, SD. B. Ashleigh Guadagnolo is with the University of Texas M.D. Anderson Cancer Center, Houston
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20
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Dwojak SM, Finkelstein DM, Emerick KS, Lee JH, Petereit DG, Deschler DG. Poor Survival for American Indians with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2014; 151:265-71. [PMID: 24781656 DOI: 10.1177/0194599814533083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/04/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine patient characteristics, treatment modalities, and human papillomavirus (HPV) prevalence to identify potential mediators of disparities that may lead to differences in outcomes for American Indians with head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Historical cohort study. SETTING Community cancer centers. PATIENTS AND METHODS We reviewed all patients older than 18 years with a new diagnosis of HNSCC in South Dakota from 1999 to 2009. We assessed tissue samples from cases of oropharyngeal cancer for the presence of HPV DNA. RESULTS In total, 474 white patients were compared with 32 American Indians. American Indians experienced significantly worse survival compared with whites (hazard ratio [HR], 0.59; P = .05), even after controlling for other factors such as age, sex, distance, Charlson comorbidity index, alcohol abuse, smoking, insurance, and disease stage. American Indians had a greater risk of alcohol abuse (68% vs 42%; P = .008), current smoking (67% vs 49%; P = .03), living more than 1 hour from a cancer center (81% vs 30%; P < .001), lacking private insurance (24% vs 68%; P < .001), and late-stage disease presentation (stages III and IV) (74% vs 55%; P = .04). There were no detected differences in age, sex, medical comorbidities, tumor site, tumor grade, HPV status, time to treatment, or type of treatment received. CONCLUSION American Indians in South Dakota with HNSCC have poorer survival compared with white patients. Once presented to a cancer center, American Indians received nearly identical treatment to white patients. Disparities in outcomes arise primarily due to sociodemographic factors and later stage at presentation.
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Affiliation(s)
- Sunshine M Dwojak
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - Dianne M Finkelstein
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - John H Lee
- Sanford Cancer Research Center, Sioux Falls, South Dakota, USA
| | - Daniel G Petereit
- Rapid City Regional Hospital, John T. Vucurevich Cancer Care Institute, Rapid City, South Dakota, USA
| | - Daniel G Deschler
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
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