Disparities in head and neck cancer (HNC): An insight of the National Inpatient (NIS) database.
Authors: Perez Esmirna , Chapiolkina Volha , Guevara-Rodriguez Nehemias Antonio , Ghimire Manoj , Shrestha Karun , Florez Narjust , Olazagasti Coral 
Published: May 2024

e13730

Background: Despite the decline in tobacco use, the incidence of head and neck cancers continues to increase in part due to HPV. HNC accounts for 4% of all cancers in the United States (USA), with particularly high morbidity in oncology. There is a complex interplay of factors that contributes to the incidence and prevalence of HNC; among these, sociodemographic characteristics and net income are notably linked to poorer outcomes within African American and Latino communities. Interestingly, despite a higher incidence in the White population, disparities persist. Consequently, there is a pressing need for a more nuanced characterization to comprehensively grasp the impact of sociodemographic factors on HNC outcomes. Methods: This was a retrospective cohort analysis of adults admitted to hospitals in the USA between 2016 and 2020 with a primary diagnosis of HNC. Data was obtained from the NIS Database, the largest publicly available inpatient database in USA, with over 7 million in-hospital stays per year. The primary outcome was to describe the trends of HNC, comparing sociodemographic characteristics. Secondary outcomes included the impact of being cared for in Teaching Hospitals (TH) vs. nonteaching hospitals (NTH) and length of stay (LoS). Hypothesis testing for categorical variables was tested with Chi-Square. Continuous variables were tested with a Student's t-test. Statistical significance was defined as a two-tailed P value of <0.05. Results: 191,740 patients met inclusion criteria: patients admitted between January 2016 and December 2020 under the primary diagnosis of HNC, corresponding to the billable code of the International Classification of Diseases 10th Revision, and patients 18 and older. Of all patients, 159,985 were admitted to TH and 31,755 in NTH. The most common geographic locations were the south region, 34% vs 46%, and the central region, 24% vs 20% for TH and NTH, respectively. The mean patient age was 62 in TH and 65.4 in NTH (p<0.001). The most affected sex was male. Hospitalization LoS (median) was 6.3 days in TH and 5.4 days in NTH (p<0.001). Furthermore, mortality was higher in NTH 7.51% vs 4.87% in TH (p<0.001). Most patients had a lower income: 50% in TH vs 62% in NTH had an income under the 50 bracket (p<0.001). White was the most common race among admitted patients (p<0.001). Chronic kidney disease, obesity, and coronary artery disease were significantly associated comorbidities (p<0.001). The two most commonly described complications during admission were AKI (p= 0.58) and mechanical ventilation (p=0.55). Conclusions: Low income is associated with higher mortality in patients with HNC. Socioeconomic determinants of health have been shown to have a predominant influence on outcomes over classic risk factors. Despite a greater LoS in teaching hospitals, this was inversely related to mortality, which could be associated with a more comprehensive diagnostic process and cancer-related care.