Socioeconomic status, access to care, risk factor patterns, and stage at diagnosis for head and neck cancer among black and white patients

Abstract

Background Little is known about how factors combine to influence progression of squamous cell carcinoma of the head and neck (HNSCC). We aimed to evaluate multidimensional influences of factors associated with HNSCC stage by race. Methods Using retrospective data, patients with similar socioeconomic status (SES), access to care (travel time/distance), and behavioral risk factors (tobacco/alcohol use and dental care) were grouped by latent class analysis. Relative frequency differences (RFD) were calculated to evaluate latent classes by stage, race, and p16 status. Results We identified three latent classes. Advanced T‐stage was higher for black (RFD = +20.2%; 95% CI: −4.6 to 44.9) than white patients (RFD = +10.7%; 95% CI: 2.1–19.3) in the low‐SES/high‐access/high‐behavioral risk class and higher for both black (RFD = +29.6%; 95% CI: 4.7–54.5) and white patients (RFD = +23.9%; 95% CI: 15.2–32.6) in the low‐SES/low‐access/high‐behavioral risk class. Conclusion Results suggest that SES, access to care, and behavioral risk factors combine to underly the association with advanced T‐stage. Additionally, differences by race warrant further investigation.

Racial Disparities in Head and Neck Cancer: It's Not Just About Access

“…Longer drive time to the hospital was associated with advanced T-stage at presentation in low SES patients. 35 Farther travel distance to the treating hospital was associated with increased 90-day mortality in low SES patients. 42 NHB and Hispanic patients, as well as patients with Medicaid insurance, were more likely to live far from treating hospital and less likely to travel long distances for HNC treatment, thus they were more likely to be lost to follow up and experience inferior outcomes.…”

“…Medicaid and lack of insurance coverage were associated with lower utilization of health cancer screenings, delayed diagnosis of HNC, and poorer HNC outcomes. 2,35,42,52 In the United States, NHB patients were more likely than NHW patients to utilize Medicaid or present as uninsured. 6 Uninsured NHB patients were more likely to be diagnosed with advanced stage HNC, and they had poorer OS compared to NHB patients with private insurance coverage.…”

“…Distance from the treating hospital was found to be negatively associated with adherence to follow-up for HNC care, longer treatment package time, and higher mortality rates. 35,42,53,[65][66][67] It is important to note that variables such as drive time and travel distance were defined differently among studies and thus, may not be directly comparable. For example, some studies evaluated drive time while others evaluated public transit time, walking distance, or distance directly from point A to point B (as the crow flies).…”

“…42 NHB and Hispanic patients, as well as patients with Medicaid insurance, were more likely to live far from treating hospital and less likely to travel long distances for HNC treatment, thus they were more likely to be lost to follow up and experience inferior outcomes. 35,42,53,66,68,69 However, patients with the means to travel long distances for treatment at higher-quality hospitals experienced improved OS. 66,69 Three of the 5 SDOHs: education, economics, and health care access/quality were represented in this section.…”

“…44 However, when low-income NHB and NHW patients were compared, advanced T-stage at initial presentation was nearly twice as high among NHB patients. 35,45…”