Persistent poverty disparities in incidence and outcomes among oral and pharynx cancer patients

Shama Karanth; Shilpi Mistry; Meghann Wheeler; Tomi Akinyemiju; Joel Divaker; Jae Jeong Yang; Hyung-Suk Yoon; Dejana Braithwaite

doi:10.1007/s10552-024-01867-3

Persistent poverty disparities in incidence and outcomes among oral and pharynx cancer patients

Cancer Causes Control. 2024 Mar 23. doi: 10.1007/s10552-024-01867-3. Online ahead of print.

Authors

Shama Karanth^#^{1

2}, Shilpi Mistry^#³, Meghann Wheeler³, Tomi Akinyemiju⁴, Joel Divaker⁵, Jae Jeong Yang^{5

6}, Hyung-Suk Yoon^{5

6}, Dejana Braithwaite^{5

6

3}

Affiliations

¹ Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. shama.karanth@ufl.edu.
² University of Florida Health Cancer Center, 2004 Mowry Road, Gainesville, FL, 32610, USA. shama.karanth@ufl.edu.
³ Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA.
⁴ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
⁵ Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
⁶ University of Florida Health Cancer Center, 2004 Mowry Road, Gainesville, FL, 32610, USA.

^# Contributed equally.

PMID: 38520565
DOI: 10.1007/s10552-024-01867-3

Abstract

Purpose: Disparities in oral cavity and pharyngeal cancer based on race/ethnicity and socioeconomic status have been reported, but the impact of living within areas that are persistently poor at the time of diagnosis and outcome is unknown. This study aimed to investigate whether the incidence, 5-year relative survival, stage at diagnosis, and mortality among patients with oral cavity and pharyngeal cancers varied by persistent poverty.

Methods: Data were drawn from the SEER database (2006-2017) and included individuals diagnosed with oral cavity and pharyngeal cancers. Persistent poverty (at census tract) is defined as areas where ≥ 20% of the population has lived below the poverty level for ~ 30 years. Age-adjusted incidence and 5-year survival rates were calculated. Multivariable logistic regression was used to estimate the association between persistent poverty and advanced stage cancer. Cumulative incidence and multivariable subdistribution hazard models were used to evaluate mortality risk. In addition, results were stratified by cancer primary site, sex, race/ethnicity, and rurality.

Results: Of the 90,631 patients included in the analysis (61.7% < 65 years old, 71.6% males), 8.8% lived in persistent poverty. Compared to non-persistent poverty, patients in persistent poverty had higher incidence and lower 5-year survival rates. Throughout 10 years, the cumulative incidence of cancer death was greater in patients from persistent poverty and were more likely to present with advanced-stage cancer and higher mortality risk. In the stratified analysis by primary site, patients in persistent poverty with oropharyngeal, oral cavity, and nasopharyngeal cancers had an increased risk of mortality compared to the patients in non-persistent poverty.

Conclusion: This study found an association between oral cavity and pharyngeal cancer outcomes among patients in persistent poverty indicating a multidimensional strategy to improve survival.

Keywords: Cancer disparities; Oral and pharynx cancer; Race; Survival.