Saint Louis University School of Medicine, Saint Louis, United States.
Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, United States.
Oral Oncol. 2019 Feb;89:95-101. doi: 10.1016/j.oraloncology.2018.12.023. Epub 2018 Dec 29.
To quantify head and neck cancer (HNC) mortality rates and identify racial and socioeconomic factors associated with 90-day mortality.
The National Cancer Database (2004-2014) was queried for eligible HNC cases (n = 260,011) among adults treated with curative intent. Outcome of interest was any-cause 90-day mortality. Kaplan-Meier curves (Log-rank tests) estimated crude survival differences. A Cox proportional hazards model with further adjustments using the Šidák multiple comparison method adjusted for racial, socioeconomic and clinical factors.
There were 9771 deaths (90-day mortality rate = 3.8%). There were crude differences in sex, race/ethnicity, comorbidity, distance, income, and insurance (Log-rank p-value < 0.0001). In the final model, blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) had greater 90-day mortality hazard, as did those uninsured (aHR = 1.72; 95% CI 1.48, 1.99), covered by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53). Residence in lower median income zip code was associated with greater 90-day mortality [(aHR <$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000-$34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000-$45,999 = 1.18; 95% CI 1.08, 1.27)]; and farther travel distance for treatment was associated with decreased 90-day mortality [(aHR 50-249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR > 250 miles = 0.70; 95% CI 50, 0.99)].
There are significant race and socioeconomic disparities among patients with HNC, and these disparities impact mortality within 90 days of treatment.
量化头颈部癌症（HNC）的死亡率，并确定与 90 天死亡率相关的种族和社会经济因素。
从国家癌症数据库（2004-2014 年）中查询接受根治性治疗的成年人中符合条件的 HNC 病例（n=260011）。研究结果为任何原因的 90 天死亡率。使用 Kaplan-Meier 曲线（对数秩检验）估计粗生存率差异。使用Šidák 多重比较法进一步调整 Cox 比例风险模型，调整种族、社会经济和临床因素。
有 9771 人死亡（90 天死亡率=3.8%）。在性别、种族/民族、合并症、距离、收入和保险方面存在明显差异（对数秩 p 值<0.0001）。在最终模型中，黑人（aHR=1.10，95%CI 1.00，1.21）和男性（aHR=1.07；95%CI 1.00，1.15）的 90 天死亡率更高，无保险（aHR=1.72；95%CI 1.48，1.99）、接受医疗补助（aHR=1.72；95%CI 1.53，1.93）或医疗保险（aHR=1.40；95%CI 1.27，1.53）的患者也是如此。居住在中位收入较低的邮政编码地区与较高的 90 天死亡率相关[(aHR<$30000=1.30；95%CI 1.18，1.44)；(aHR$30000-34999=1.24；95%CI 1.13，1.36)；(aHR$35000-45999=1.18；95%CI 1.08，1.27)]；而治疗的旅行距离较远与 90 天死亡率降低相关[(aHR 50-249.9 英里=0.86；95%CI 0.77，0.97)；(aHR>250 英里=0.70；95%CI 50，0.99)]。
HNC 患者存在显著的种族和社会经济差异，这些差异会影响治疗后 90 天内的死亡率。
