Assessments of social vulnerability on laryngeal cancer treatment & prognosis in the US.

BACKGROUND

Previous social determinants of health (SDoH) studies on laryngeal cancer (LC) have assessed individual factors of socioeconomic status and race/ethnicity but seldom investigate a wider breadth of SDoH-factors for their effects in the real-world. This study aims to delineate how a wider array of SDoH-vulnerabilities interactively associates with LC-disparities.

METHODS

This retrospective cohort study assessed 74,495 LC-patients between 1975 and 2017 from the Surveillance-Epidemiology-End Results (SEER) database using the Social Vulnerability Index (SVI) from the CDC, total SDoH-vulnerability from 15 SDoH variables across specific vulnerabilities of socioeconomic status, minority-language status, household composition, and infrastructure/housing and transportation, which were measured across US counties. Univariate linear and logistic regressions were performed on length of care/follow-up and survival, staging, and treatment across SVI scores.

RESULTS

Survival time dropped significantly by 34.37% (from 72.83 to 47.80 months), and surveillance time decreased by 28.09% (from 80.99 to 58.24 months) with increasing overall social vulnerability, alongside advanced staging (OR 1.15; 95%CI 1.13-1.16), increased chemotherapy (OR 1.13; 95%CI 1.11-1.14), decreased surgical resection (OR 0.91; 95%CI 0.90-0.92), and decreased radiotherapy (OR 0.97; 95%CI 0.96-0.99).

DISCUSSION

In this SDoH-study of LCs, detrimental care and prognostic trends were observed with increasing overall SDoH-vulnerability.