Head and Neck Cancer Survival Disparities by Race and Rural-Urban Context
Menée aux Etats-Unis à l'aide de données 2004-2015 portant sur 146 256 patients atteints d'un cancer de la tête et du cou, cette étude analyse l'association entre des facteurs de disparités ethniques ou liées au lieu de résidence (zone urbaine ou rurale) et la survie
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.