Higher area deprivation index is associated with poorer local control and overall survival in non-metastatic nasopharyngeal carcinoma

Head Neck. 2024 Jun;46(6):1468-1474. doi: 10.1002/hed.27751. Epub 2024 Mar 22.

Abstract

Background: Neighborhood socioeconomic deprivation impacts outcomes in various cancers. We examined this association in nasopharyngeal carcinoma (NPC) patients using the area deprivation index (ADI).

Methods: We conducted a single-institution retrospective cohort study on NPC patients treated with definitive radiotherapy from 1980 to 2023. ADI was used as the primary exposure measure. Higher ADI indicates higher levels of socioeconomic deprivation.

Results: Of 561 patients, those with higher ADI (6-10 vs. 1-5) presented more commonly with AJCC stage III/IV compared to I/II (87% vs. 76%, p = 0.03). Increasing ADI decile score correlated with poorer overall survival (HR 1.14, 95% CI 1.01-1.28, p = 0.04). Local control was worse in patients from the most deprived quartile in the cohort ADI 5-10 (HR 2.11, 95% CI 1.01-4.41, p = 0.05).

Conclusions: NPC patients from more disadvantaged neighborhoods undergoing radiotherapy had worse local control and survival outcomes. Interventions to address structural determinants of health and neighborhood disparities may improve these outcomes.

Keywords: area deprivation index; disparities; head and neck cancer; nasopharynx cancer; neighborhood deprivation.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma* / mortality
  • Nasopharyngeal Carcinoma* / pathology
  • Nasopharyngeal Carcinoma* / radiotherapy
  • Nasopharyngeal Carcinoma* / therapy
  • Nasopharyngeal Neoplasms* / mortality
  • Nasopharyngeal Neoplasms* / pathology
  • Nasopharyngeal Neoplasms* / radiotherapy
  • Neighborhood Characteristics
  • Neoplasm Staging
  • Retrospective Studies
  • Socioeconomic Factors
  • Survival Rate