Bruss David M, Fei-Zhang David J, Kim Helena, Chelius Daniel C, Sheyn Anthony M, Maddalozzo John P, Rastatter Jeffrey C, D'Souza Jill N
Department of Otolaryngology, University of Illinois at Chicago - College of Medicine, Chicago, Illinois, USA.
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Head Neck. 2025 Feb;47(2):538-548. doi: 10.1002/hed.27930. Epub 2024 Sep 25.
Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC).
The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality.
Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01-1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01-1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91-0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods.
Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.
技术和互联网接入已日益融入医疗保健领域，成为健康相关信息及医患沟通的主要平台。美国在获取数字资源方面存在差距，且已表明这会影响各种头颈恶性肿瘤的健康结局。我们的目标是评估数字不平等与涎腺癌（SGC）患者健康结局之间的关联。
数字不平等指数（DII）是利用从美国社区调查和联邦通信委员会获得的17个普查区层面变量制定的。变量分为数字基础设施或社会人口统计学（如非数字）变量，并根据全美各县的相对排名进行评分。根据居住县，为2013年至2017年间在监测、流行病学和最终结果（SEER）数据库中诊断为SGC的患者分配分数。对DII分数与监测时间、生存时间、诊断时肿瘤分期及治疗方式等结局进行回归分析。
在9306例SGC患者中，在考虑传统社会人口统计学因素后，数字不平等加剧与就诊时分期较晚（比值比：1.04，95%置信区间：1.01 - 1.07，p = 0.033）、接受化疗的几率增加（比值比：1.05，置信区间：1.01 - 1.10，p = 0.010）以及手术干预几率降低（比值比：0.94，95%置信区间：0.91 - 0.98，p = 0.003）相关。数字不平等加剧还与监测时间和生存期缩短相关。
数字不平等与SGC患者的不良健康和治疗结局显著且独立相关，凸显了直接努力解决这些鲜少被研究的健康差距驱动因素的重要性。
