Head and Neck Cancer Survival Disparities by Race and Rural-Urban Context

Head and Neck Cancer

Cancer Epidemiol Biomarkers Prev. 2020 Jul 29:cebp.0376.2020. doi: 10.1158/1055-9965.EPI-20-0376. Online ahead of print.


BACKGROUND: This study aims to examine the relationship between race and rural-urban context in head and neck cancer (HNC) survival and determine factors that potentially drive this disparity.

METHODS: Using the National Cancer Database from 2004 to 2015, we identified a retrospective cohort of 146,256 HNC patients. Kaplan-Meier survival curves and the Cox proportional hazards regression were used to calculate adjusted hazard ratios (aHR).

RESULTS: Median survival by patient subgroup was as follows: white urban (67 mo.; 95% Confidence Interval [CI]: 66.0-67.9), white rural (59.1 mo.; 95% [CI]: 57.2-60), black urban (43.1 mo.; 95% [CI]: 41.1-44.5) and black rural (35.1 mo.; 95% [CI]: 31.9-39.0). The difference in five-year survival, stratified rural-urban context, was greater among black patients (ΔRMST 0.18; 95% [CI]: 0.10-0.27) than white patients (ΔRMST 0.08; 95% [CI]: 0.06-0.11). In the univariable Cox proportional hazards analysis with white urban patients as reference group, black rural patients had the worst survival (HR: 1.45; 95% [CI]: 1.43-1.48; p<.001), followed by black urban patients (HR: 1.29; 95% [CI]: 1.28-1.30; p<.001), and white rural patients (HR: 1.08 95% [CI]: 1.07-1.09; p<.001). This disparity persisted when controlling for demographic, socioeconomic, and clinical factors.

CONCLUSION: Black HNC patients, specifically those living in rural areas, have decreased survival. Survival differences by rural-urban status are greater among black patients than white patients.

IMPACT: We have shown that race and rural-urban status impact HNC survival outcomes. Our findings will help future researchers to better frame approaches to address this disparity.