Community socioeconomic status and rural/racial disparities in HPV−/+ head and neck cancer

Semprini, Jason; Williams, Jessica C.

doi:10.1016/j.tipsro.2023.100205

Cited by 5 publications

(1 citation statement)

References 40 publications

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“…This result is important since adults, specifically low-income, rural, and racially minoritized populations face additional access barriers to dental care. 15,47,48 This also highlights the limitations of access to Medicaid dental benefits for improving oral cancer detection in low-income adults, who reside in areas without adequate providers. This problem is likely even further exacerbated when considering the extra difficulty of finding providers who accept Medicaid dental insurance.…”

Section: Discussionmentioning

confidence: 98%

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Semprini,

Reynolds,

Zahnd

et al. 2024

Cancer Medicine

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BackgroundDespite the importance of regular dental visits for detecting oral cancer, millions of low‐income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees.MethodsWe analyzed Surveillance, Epidemiology, and End Results‐Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference‐in‐differences model. Our design compares the change in early‐stage (Stages 0–II) diagnoses before and after dropping dental benefits in California with the change in early‐stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non‐OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita.ResultsDropping Medicaid dental benefits was associated with a 6.5%‐point decline in early‐stage diagnoses of non‐OPC (95% CI = −14.5, −3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%‐point decline in the probability of early‐stage non‐OPC diagnoses for every additional dentist per 5000 population (p = 0.006).ConclusionsEliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.

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Section: Discussionmentioning

confidence: 98%

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Semprini,

Reynolds,

Zahnd

et al. 2024

Cancer Medicine

Self Cite

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Effect of Rurality in Head and Neck Cancer: A Scoping Review

Tomescu,

Sullivan,

Davies

et al. 2024

The Laryngoscope

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ObjectivesThis scoping review sought to evaluate the current literature regarding the following outcomes in relation to rurality: stage at diagnosis, clinical characteristics, treatment characteristics, and survival outcomes of head and neck cancer (HNC).Data SourcesA literature search was performed using PubMed (MEDLINE), Science Direct, EMBASE, SCOPUS, and Web of Science databases.Review MethodsA 20‐year study cutoff from the initial search was used to increase the comparability of the studies regarding population and standards of clinical care. These searches were designed to capture all primary studies reporting HNC incidence, presenting characteristics, treatments, and treatment outcomes. Two reviewers independently screened abstracts, selected articles for exclusion, extracted data, and appraised studies. Critical appraisal was done according to the Joanna Briggs Institute Quality Assessment Tool for Cohort Studies.FindingsTwenty eligible original articles were included. Stage at diagnosis, clinical characteristics, treatment characteristics, and survival outcomes were measured. Our review indicates that although this relationship is unclear, there may be variations in treatment choice for laryngeal cancer based on geographic location and rural residency status. The studies assessing HNC outcomes related to stage at diagnosis, clinical characteristics, treatment characteristics, and overall survival demonstrated conflicting findings, indicating a need for further research examining HNC outcomes with a focus on rurality as the main exposure.ConclusionsThe relationship between HNC and rural‐urban status remains unclear. More studies are needed, along with a consistent metric for measuring rurality and recruitment of comparable populations from both rural and urban areas. Laryngoscope, 2024

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Effects of Rurality, Socioeconomic Status, and Race on Head and Neck Squamous Cell Carcinoma Outcomes

Torres‐Small,

Davies,

Kumsa

et al. 2024

The Laryngoscope

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ObjectiveTo examine how rural residence interacts with SES and race/ethnicity relative to Head and neck squamous cell carcinoma (HNSCC) treatment delay and outcomes.MethodsThe SEER database was queried for patients aged ≥18 with HNSCC. Out of 164,337 cases, 126,052 remained after exclusions for missing data. Statistical tests performed included Chi‐squared tests, log‐binomial regression models, and parametric accelerated failure time (AFT) models, with a significance level of α < 0.05.ResultsAbout 38% of patients residing in lowest SES census tracts were rural, whereas over 98% of patients from highest SES tracts were urban. Delayed treatment was associated with shorter median survival [aTR = 0.968, 95% confidence interval (CI): 0.939, 0.999]. Risk for treatment delay increased with decreasing SES and was greater for those with minoritized race/ethnicity status. Rurality was associated with a lower risk [aRR: 0.917, 95% CI: 0.892, 0.946] of treatment delays but was not predictive for patient survival (aTR: 1.019 [0.978, 1.061]). Cancer‐specific mortality increased with decreasing SES and was higher in patients with minoritized race/ethnicity status.ConclusionRurality was associated with decreased risk for treatment delay but not with worse survival relative to urban residence, whereas low SES and minority status remained predictive for poor outcome regardless of geographic context (level of evidence: 4). Although these findings argue against HNSCC survival deficits specific to rural populations, there remains concern regarding potential care shortfalls in rural populations not detected in this sample. Confirmatory patient‐level analysis should be prioritized to optimize support along the rural/urban divide.Level of EvidenceIV Laryngoscope, 2024

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Community socioeconomic status and rural/racial disparities in HPV−/+ head and neck cancer

Cited by 5 publications

References 40 publications

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Effect of Rurality in Head and Neck Cancer: A Scoping Review

Effects of Rurality, Socioeconomic Status, and Race on Head and Neck Squamous Cell Carcinoma Outcomes

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