Disparities in Survival Outcomes among Racial/Ethnic Minorities with Head and Neck Squamous Cell Cancer in the United States
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. Demographic and Clinical Comparisons
3.2. Survival Analysis
3.3. Analysis of Treatment Time
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Level | White (n = 262,762) | Black (n = 32,528) | NA/Other (n = 2657) | Asian (n = 6191) | Total (n = 304,138) | p-Value * |
---|---|---|---|---|---|---|---|
Age at Diagnosis | Mean (SD) (min, max) | 64 (12.2) (18, 90) | 61.2 (11.1) (18, 90) | 61.4 (12.4) (20, 90) | 61 (14.1) (18, 90) | 63.6 (12.1) (18, 90) | <0.0001 |
Site | Oral Cavity | 134,941 (51%) | 10,714 (33%) | 1297 (49%) | 3170 (51%) | 150,122 (49%) | <0.0001 |
Hypopharynx | 14,669 (6%) | 2998 (9%) | 185 (7%) | 339 (5%) | 18,191 (6%) | ||
Larynx | 84,446 (32%) | 14,203 (44%) | 844 (32%) | 1112 (18%) | 100,605 (33%) | ||
Nasal Cavity | 7816 (3%) | 940 (3%) | 82 (3%) | 248 (4%) | 9086 (3%) | ||
Nasopharynx | 5622 (2%) | 1153 (4%) | 115 (4%) | 1141 (18%) | 8031 (3%) | ||
Oropharynx | 11,396 (4%) | 2000 (6%) | 95 (4%) | 121 (2%) | 13,612 (4%) | ||
Pharynx | 3872 (1%) | 520 (2%) | 39 (1%) | 60 (1%) | 4491 (1%) | ||
Sex | Female | 73,263 (28%) | 8255 (25%) | 682 (26%) | 1899 (31%) | 84,099 (28%) | <0.0001 |
Male | 189,499 (72%) | 24,273 (75%) | 1975 (74%) | 4292 (69%) | 220,039 (72%) | ||
Ethnicity | Hispanic | 11,036 (4%) | 269 (1%) | 553 (23%) | 47 (1%) | 11,905 (4%) | <0.0001 |
Non-Hispanic | 238,635 (96%) | 30,764 (99%) | 1848 (77%) | 5958 (99%) | 277,205 (96%) | ||
Insurance | Not Insured | 11,968 (5%) | 2884 (9%) | 207 (8%) | 404 (7%) | 15,463 (5%) | <0.0001 |
Private Insurance/Managed Care | 98,657 (38%) | 8051 (25%) | 903 (34%) | 2719 (44%) | 110,330 (36%) | ||
Medicaid | 21,348 (8%) | 7111 (22%) | 395 (15%) | 947 (15%) | 29,801 (10%) | ||
Medicare | 119,955 (46%) | 12,766 (39%) | 891 (34%) | 1943 (31%) | 135,555 (45%) | ||
Other Government | 5279 (2%) | 707 (2%) | 139 (5%) | 44 (1%) | 6169 (2%) | ||
Insurance Status Unknown | 5555 (2%) | 1009 (3%) | 122 (5%) | 134 (2%) | 6820 (2%) | ||
Income | <$30,000 | 33,005 (13%) | 13,263 (42%) | 605 (23%) | 428 (7%) | 47,301 (16%) | <0.0001 |
$30,000–$34,999 | 50,406 (20%) | 6856 (22%) | 459 (18%) | 687 (11%) | 58,408 (20%) | ||
$35,000–$45,999 | 75,161 (30%) | 6746 (21%) | 609 (24%) | 1394 (23%) | 83,910 (28%) | ||
≥$46,000 | 95,980 (38%) | 4876 (15%) | 912 (35%) | 3489 (58%) | 105,257 (36%) | ||
AJCC Clinical Stage Group (7th Edition) | 0 | 8621 (3%) | 735 (2%) | 76 (3%) | 134 (2%) | 9566 (3%) | <0.0001 |
1 | 58,039 (22%) | 4323 (13%) | 506 (19%) | 1226 (20%) | 64,094 (21%) | ||
2 | 33,649 (13%) | 3708 (11%) | 316 (12%) | 753 (12%) | 38,426 (13%) | ||
3 | 35,741 (14%) | 5161 (16%) | 396 (15%) | 915 (15%) | 42,213 (14%) | ||
4 | 76,887 (29%) | 12,662 (39%) | 827 (31%) | 1886 (30%) | 92,262 (30%) | ||
4C | 5187 (2%) | 1286 (4%) | 77 (3%) | 176 (3%) | 6726 (2%) | ||
Surgery | Primary Site only | 68,269 (26%) | 4906 (15%) | 560 (21%) | 1367 (22%) | 75,102 (25%) | <0.0001 |
Primary and Lymph Node | 64,837 (25%) | 6424 (20%) | 740 (28%) | 1897 (31%) | 73,898 (24%) | ||
Lymph Node only | 13,080 (5%) | 1141 (4%) | 125 (5%) | 373 (6%) | 14,719 (5%) | ||
No primary or lymph Node | 116,576 (44%) | 20,057 (62%) | 1232 (46%) | 2554 (41%) | 140,419 (46%) | ||
Palliative Care | No palliative care provided | 256,845 (98%) | 31,377 (96%) | 2546 (96%) | 6053 (98%) | 296,821 (98%) | <0.0001 |
Surgery | 1046 (0%) | 192 (1%) | 12 (0%) | 27 (0%) | 1277 (0%) | ||
Radiation Therapy | 1391 (1%) | 368 (1%) | 23 (1%) | 24 (0%) | 1806 (1%) | ||
Chemo/hormone/other systemic drugs | 811 (0%) | 205 (1%) | 12 (0%) | 17 (0%) | 1045 (0%) | ||
Pain management | 799 (0%) | 117 (0%) | 6 (0%) | 27 (0%) | 949 (0%) | ||
Other | 947 (0%) | 201 (1%) | 14 (1%) | 41 (1%) | 1203 (0%) | ||
Unknown | 923 (0%) | 68 (0%) | 44 (2%) | 2 (0%) | 1037 (0%) | ||
Charlson–Deyo Score | 0 | 199,731 (76%) | 23,922 (74%) | 2048 (77%) | 4985 (81%) | 230,686 (76%) | <0.0001 |
1 | 46,509 (18%) | 6131 (19%) | 455 (17%) | 976 (16%) | 54,071 (18%) | ||
2 | 12,084 (5%) | 1602 (5%) | 116 (4%) | 178 (3%) | 13,980 (5%) | ||
3 | 4438 (2%) | 873 (3%) | 38 (1%) | 52 (1%) | 5401 (2%) | ||
Metastatic Disease | No | 246,892 (98%) | 29,638 (95%) | 2469 (97%) | 5613 (96%) | 284,612 (97%) | <0.0001 |
Yes | 6248 (2%) | 1467 (5%) | 86 (3%) | 222 (4%) | 8023 (3%) | ||
Chemotherapy | No | 135,110 (58%) | 13,523 (47%) | 1323 (56%) | 2837 (52%) | 152,793 (57%) | <0.0001 |
Yes | 98,139 (42%) | 15,122 (53%) | 1032 (44%) | 2597 (48%) | 116,890 (43%) | ||
Radiation (RT) | No | 99,367 (39%) | 9483 (30%) | 1017 (39%) | 2312 (38%) | 112,179 (38%) | <0.0001 |
Yes | 158,685 (61%) | 22,223 (70%) | 1563 (61%) | 3739 (62%) | 186,210 (62%) | ||
HPV Status | Negative | 28,293 (19%) | 3717 (21%) | 350 (21%) | 931 (24%) | 33,291 (20%) | <0.0001 |
Positive | 16,859 (11%) | 1128 (6%) | 132 (8%) | 236 (6%) | 18,355 (11%) | ||
Unknown | 102,171 (69%) | 12,586 (72%) | 1154 (71%) | 2763 (70%) | 118,674 (70%) | ||
Total dose | Median [IQR] | 6000 [0, 7000] | 6300 [0, 7000] | 5412 [0, 7000] | 6000 [0, 7000] | 6000 [0, 7000] | <0.0001 |
Great Circle Distance | Median [IQR] (min, max) | 12.6 [5, 31.5] (0, 4960.8) | 6.5 [3, 16.6] (0, 1938) | 12.7 [5, 36.2] (0.1, 2447.2) | 7.8 [4, 15.4] (0, 4963.1) | 11.6 [5, 29.6] (0, 4963.1) | <0.0001 |
Surgery to Start of RT interval | <6 weeks | 20,359 (42%) | 1939 (36%) | 162 (33%) | 439 (35%) | 22,899 (41%) | <0.0001 |
≥6 weeks | 28,590 (58%) | 3515 (64%) | 324 (67%) | 824 (65%) | 33,253 (59%) | ||
Distance | <4.8 | 60,996 (23%) | 12,761 (39%) | 619 (23%) | 1972 (32%) | 76,348 (25%) | <0.0001 |
4.8–29.7 | 132,913 (51%) | 14,741 (45%) | 1296 (49%) | 3547 (57%) | 152,497 (50%) | ||
>29.7 | 68,853 (26%) | 5026 (15%) | 742 (28%) | 672 (11%) | 75,293 (25%) | ||
Total Treatment Time | Median [IQR] | 101 [80, 135] | 107 [84, 145] | 107 [83, 146] | 107 [85, 142] | 102 [81, 136] | <0.0001 |
Univariate | Multivariable | ||||
---|---|---|---|---|---|
HR (95%CL) | p-Value | HR (95%CL) | p-Value | ||
Age | 1.03 (1.02 1.03) | <0.0001 | 1.02 (1.02 1.03) | <0.0001 | |
Sex | Male | Ref | Ref | ||
Female | 1.01 (1 1.02) | 0.0584 | 0.97 (0.94 1.01) | 0.2732 | |
Race | White | Ref | Ref | ||
Asian | 0.8 (0.77 0.84) | 0.84 (0.74 0.96) | 0.0098 | ||
Black | 1.41 (1.39 1.43) | <0.0001 | 1.09 (1.03 1.15) | 0.0018 | |
Native American/Other | 0.98 (0.93 1.04) | 0.6226 | 0.95 (0.78 1.15) | 0.6157 | |
Ethnicity | Hispanic | Ref | Ref | ||
Non-Hispanic | 1.05 (1.02 1.08) | 0.0003 | 1.31 (1.19 1.45) | <0.0001 | |
Insurance Status | Private Insurance/Managed Care | Ref | Ref | ||
Not Insured | 1.8 (1.75 1.84) | <0.0001 | 1.55 (1.43 1.68) | <0.0001 | |
Medicaid | 2.2 (2.16 2.24) | <0.0001 | 1.83 (1.73 1.94) | <0.0001 | |
Other Government | 1.69 (1.63 1.76) | <0.0001 | 1.15 (1.00 1.31) | 0.0359 | |
Income | ≥$46,000 | Ref | Ref | ||
$35,000–$45,999 | 1.18 (1.16 1.19) | <0.0001 | 1.17 (1.12 1.22) | <0.0001 | |
$30,000–$34,999 | 1.28 (1.26 1.3) | <0.0001 | 1.21 (1.15 1.27) | <0.0001 | |
<$30,000 | 1.46 (1.44 1.48) | <0.0001 | 1.26 (1.21 1.35) | <0.0001 | |
TNM Clinical Stage | 1 | Ref | Ref | ||
2 | 1.58 (1.55 1.61) | <0.0001 | 1.53 (1.43 1.64) | <0.0001 | |
3 | 1.84 (1.81 1.87) | <0.0001 | 1.89 (1.77 2.02) | <0.0001 | |
4 | 2.29 (2.26 2.33) | <0.0001 | 2.60 (2.45 2.76) | <0.0001 | |
Surgery | Primary Site Only | Ref | Ref | ||
Primary and Lymph Node | 1.3 (1.27 1.32) | <0.0001 | 0.93 (0.88 0.99) | 0.0334 | |
Lymph Node Only | 1.12 (1.09 1.15) | <0.0001 | 0.79 (0.72 0.86) | <0.0001 | |
No Primary or Lymph Node | 1.86 (1.83 1.88) | <0.0001 | 1.20 (1.13 1.27) | <0.0001 | |
Charlson Score | 0 | Ref | Ref | ||
1 | 1.38 (1.36 1.4) | <0.0001 | 1.19 (1.14 1.24) | <0.0001 | |
2 | 1.83 (1.79 1.87) | <0.0001 | 1.40 (1.30 1.50) | <0.0001 | |
3 | 2.17 (2.1 2.25) | <0.0001 | 1.94 (1.75 2.14) | <0.0001 | |
Metastatic Disease | No | Ref | Ref | ||
Yes | 3.87 (2.78 3.97) | <0.0001 | 2.40 (2.07 2.79) | <0.0001 | |
HPV Status | Positive | Ref | Ref | ||
Negative | 1.93 (1.87 2) | <0.00001 | 2.02 (1.94 2.11) | <0.0001 | |
Distance from Facility | <4.8 | Ref | Ref | ||
4.8–29.7 | 0.84 (0.83 0.85) | <0.0001 | 0.91 (0.87 0.94) | <0.0001 | |
29.7 | 0.84 (0.83 0.86) | <0.0001 | 0.93 (0.88 0.98) | <0.001 | |
Travel Distance | 1 (1 1) | <0.0001 | 1 (1 1) | 0.0213 |
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Baliga, S.; Yildiz, V.O.; Bazan, J.; Palmer, J.D.; Jhawar, S.R.; Konieczkowski, D.J.; Grecula, J.; Blakaj, D.M.; Mitchell, D.; Henson, C.; et al. Disparities in Survival Outcomes among Racial/Ethnic Minorities with Head and Neck Squamous Cell Cancer in the United States. Cancers 2023, 15, 1781. https://doi.org/10.3390/cancers15061781
Baliga S, Yildiz VO, Bazan J, Palmer JD, Jhawar SR, Konieczkowski DJ, Grecula J, Blakaj DM, Mitchell D, Henson C, et al. Disparities in Survival Outcomes among Racial/Ethnic Minorities with Head and Neck Squamous Cell Cancer in the United States. Cancers. 2023; 15(6):1781. https://doi.org/10.3390/cancers15061781
Chicago/Turabian StyleBaliga, Sujith, Vedat O. Yildiz, Jose Bazan, Joshua D. Palmer, Sachin R. Jhawar, David J. Konieczkowski, John Grecula, Dukagjin M. Blakaj, Darrion Mitchell, Christina Henson, and et al. 2023. "Disparities in Survival Outcomes among Racial/Ethnic Minorities with Head and Neck Squamous Cell Cancer in the United States" Cancers 15, no. 6: 1781. https://doi.org/10.3390/cancers15061781