Impact of neighbor-level disadvantage on survival outcomes in head and neck squamous cell carcinoma.

PURPOSE

To assess the impact of neighborhood-level disadvantage using the area disadvantage index (ADI) on survival outcomes in head and neck squamous cell carcinoma (HNSCC) patients.

METHODS

Patients diagnosed with previously untreated HNSCC from a single institutional study at a large, tertiary care hospital between 2008 and 2014 were provided self-administered questionnaires in a prospective longitudinal cohort study. Area Deprivation Index (ADI) was the primary exposure of interest, calculated using Federal Information Processing Standard (FIPS) codes that assess a neighborhood's socioeconomic conditions, where a higher ADI indicates a disadvantaged neighborhood and lower socioeconomic status. The primary outcomes of interest were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazard models.

RESULTS

The study included 792 patients. Patients with a higher ADI score were more likely to live in a less populous area (p < 0.01) and have a higher comorbidity score (p < 0.01), were heavy smokers (p < 0.01), and most cases (80.8%) tested negative for Human Papillomavirus (HPV) infection (p < 0.01). Higher terciles of ADI were associated with lower 5-year OS (p < 0.01), DSS (p = 0.01), and RFS (p = 0.03), with each 10-point increase in ADI being associated with a 1.1 times increase in hazard of death, disease-specific death, or recurrence (p < 0.01 for all). Patients in the highest tercile of ADI had significantly higher hazards of death (HR: 1.8 [1.3, 2.4], p < 0.01) and recurrence (1.4 [1.1, 1.9], p = 0.04) compared to the lowest tercile. In multivariable models, ADI was not significantly associated with OS, DSS, or RFS. Predictors of OS and DSS included HPV, stage, age, BMI, pack years, and comorbidity score, while RFS was predicted by HPV, stage, and comorbidity.

CONCLUSIONS

Higher ADI scores were linked to poorer survival outcomes in HNSCC. These findings underscore the importance of considering social determinants of health, particularly ADI components like income, employment, housing quality, and access to care, in influencing HNSCC mortality and recurrence rates.