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J Neurol Surg B Skull Base 2022; 83(05): 451-460
DOI: 10.1055/s-0041-1741111
Original Article

Impact of Race, Ethnicity, and Socioeconomic Status on Nasopharyngeal Carcinoma Disease-Specific and Conditional Survival

Ashley O. London   *
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
,
Liam W. Gallagher    *
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
,
Rahul K. Sharma
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
,
Daniel Spielman
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
,
Justin S. Golub
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
,
Jonathan B. Overdevest
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
,
Carol H. Yan
2   Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
,
Adam DeConde
2   Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
,
David A. Gudis
1   Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
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Abstract

Introduction Race, ethnicity, and socioeconomic status (SES) are complex, interconnected social determinants of health outcomes. This study uses multivariable analysis on a combination of large national datasets to examine the effects of these factors on 5-year disease-specific survival (DSS) and conditional DSS (CDSS) for nasopharyngeal carcinoma (NPC).

Methods A retrospective study of adults with NPC between 2000 and 2017 from the Surveillance, Epidemiology, End Results (SEER) registry was performed, using the National Cancer Institute Yost Index, a census tract–level composite score of SES to categorize patients. Kaplan–Meier analysis and Cox's regression for DSS and CDSS were stratified by SES. Logistic regression was conducted to identify risk factors for advanced cancer stage at time of diagnosis and receiving multimodal therapy.

Results Our analysis included 5,632 patients. DSS was significantly associated with race and SES (p < 0.01). Asian/Pacific Islander patients exhibited increased survival when controlling for other variables (hazard ratio [HR] = 0.73, p < 0.01). Although Black patients were more likely to be diagnosed with advanced disease (Black odds ratio [OR] = 1.47, p < 0.01), Black patients were also less likely to receive multimodal therapy; however, this relationship lost statistical significance once SES was incorporated into the multivariable analysis. DSS was decreased among the lowest (first) and middle (second) tertiles of SES (first HR = 1.34, p < 0.01; second HR = 1.20, p < 0.01) compared with the highest (third).

Conclusion Our results indicate that race, ethnicity, and SES significantly affect survival, stage at diagnosis, and treatment of NPC. An interplay of tumor biology and inequalities in access to care likely drives these disparities.

Keywords

nasopharyngeal carcinoma - socioeconomic status - racial disparity - health outcomes

* Denotes equal authorship




Publication History

Received: 08 May 2020

Accepted: 05 November 2021

Article published online:
29 December 2021

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