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.

中文翻译：

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口腔癌和咽癌患者的发病率和结果持续存在贫困差异

目的

据报道，口腔癌和咽癌因种族/民族和社会经济地位而存在差异，但生活在诊断和结果时持续贫困地区的影响尚不清楚。本研究旨在调查口腔癌和咽癌患者的发病率、5 年相对生存率、诊断分期和死亡率是否因持续贫困而变化。

方法

数据取自 SEER 数据库（2006-2017 年），包括被诊断患有口腔癌和咽癌的个体。持续贫困（在人口普查区）被定义为 ≥ 20% 的人口生活在贫困线以下约 30 年的地区。计算年龄调整后的发病率和 5 年生存率。使用多变量逻辑回归来估计持续贫困与晚期癌症之间的关联。使用累积发生率和多变量次分布风险模型来评估死亡风险。此外，结果按癌症原发部位、性别、种族/民族和农村地区进行分层。

结果

在纳入分析的 90,631 名患者中（61.7% < 65 岁，71.6% 男性），8.8% 生活在持续贫困中。与非持续性贫困相比，持续性贫困患者的发病率较高，5年生存率较低。十年来，持续贫困的患者癌症死亡的累积发生率更高，并且更有可能出现晚期癌症和更高的死亡风险。在按原发地进行的分层分析中，与非持续贫困的患者相比，患有口咽癌、口腔癌和鼻咽癌的持续贫困患者的死亡风险较高。

结论

这项研究发现持续贫困患者的口腔癌和咽癌结果之间存在关联，表明需要采取多维策略来提高生存率。