Socioeconomic inequalities in the survival of head and neck cancer is a widespread concern in developing countries. In Brazil, there are severe social disparities that include access to healthcare. In this context, we investigated whether social inequalities impact the overall survival of patients diagnosed with larynx, oral cavity, and oropharynx cancers in São Paulo State (2000-2018). This hospital-based cohort study used data provided by the São Paulo Oncocentro Foundation (FOSP) in São Paulo State, Brazil. The 5-year overall survival (OS) was assessed by the Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models to calculate the hazard ratio (HR). We considered a confidence level of 95% (95%CI) to indicate statistical significance. Out of the 816,393 cases recorded in the São Paulo State, a total of 37,191 cases occurred in larynx (n = 12,095), oral cavity (n = 12,858), and oropharynx (n = 12,238). The OS was 40.3%, 31.7%, and 23.6% for larynx, oral cavity, and oropharynx cancers, respectively. In multivariable Cox regression, formal education lower than 9 years increased the risk of death in oropharynx cancers (HR = 1.11; 95%CI= 1.05; 1.17), oral cavity cancers (HR = 1.06; 95%CI= 1.01; 1.12), and larynx cancers (HR = 1.09; 95%CI= 1.03; 1.16). The public healthcare assistance has shown to be a factor for a higher risk of death by 79% for oropharynx in comparison to private healthcare assistance, adjusted by age group, gender, clinical staging, and therapy modalities (chemotherapy, radiotherapy, and surgery). In conclusion, there is a remarkable social inequality at individual level in São Paulo State that poses a challenge to public the health in order to improve the overall survival in Brazilian patients. Key messages Social inequalities reduce the overall survival in oropharynx, oral cavity, and larynx cancers in São Paulo State, Brazil. Tackling social disparities is crucial since they play an essential role in the prognosis of Brazilian patients with oropharynx, oral cavity, and larynx cancers.

The Health, Well-being and Aging (SABE - Saúde, Bem-estar e Envelhecimento) study was developed by the Pan American Health Organization (OPAS/OMS) to provide information on the living conditions of the elderly. The multi-center survey on health and well-being of the elderly was carried out in seven urban areas in Latin America and the Caribbean. The study took place between October 1999 and December 2000 in Argentina, Barbados, Brazil, Chile, Cuba, Mexico, and Uruguay. In 2006, only in Brazil, the SABE Study became a longitudinal and multiple cohort study with the aid of the São Paulo Research Foundation (FAPESP) and the Ministry of Health. In each cohort (2006, 2010 and 2015), data was collected among the elderly who were participants in 2000, and new 60 to 64-year-old subjects were inserted. The probabilistic sample of the participating individuals was obtained through the method of multi-stage conglomerates sampling by stratifying the primary units. We also considered the socioeconomic strata of the municipality urban area. The baseline for carrying out the sample calculation was the population count of the Brazilian Institute of Geography and Statistics (IBGE). Data was collected by trained interviewers. They used a standardized questionnaire to retrieve information regarding, for example, cognitive assessment, health status, and use and access to services. At the moment, the SABE Study follows 1,224 elderly individuals. The information collected from the SABE Study is available through the electronic address <http://hygeia3.fsp.usp.br/sabe/>. The aging process occurs differently when factors such as sex and socioeconomic aspects are considered. Thus, accompanying the elderly over time and knowing their living conditions are essential for proposing public policies according to reality. Key messages The Health, Well-being and Aging (SABE) study has been monitoring elderly people since 2000 in the city of São Paulo and provides information on their living conditions. The monitoring of the elderly enables the development of public policies that are more focused on the needs presented.