Abstract 1177: Insurance status and racial disparities in mortality for black and white head and neck cancer patients in the United States
Authors: Marshall Dana R. , Amponsem Joycemary , Ballard Billy R. , Kadmiri Mohammed A. El , Kim Young J. , Wilus Derek , Tabatabai Mohammad A. 
Published: September 2020

Historically, and currently, black males have the highest mortality rates of any demographic group defined by race plus gender. Even though incidence has dropped for all demographic groups, and survival has improved as well, black males still bare a disproportionate burden of mortality. It has been reported that even when controlling for variables associated with prognosis, including socioeconomic status, black males still die at higher rates than white males. The question is whether this is true when one focuses on patients in lower socioeconomic groups where baseline health is poor for both blacks and whites. We hypothesized that patients in the lowest socioeconomic tertile would have a life expectancy that was significantly reduced compared to those of higher socioeconomic tertiles regardless of race, tumor grade, age at diagnosis, insurance status, anatomic subsite of the cancer and HPV status (all factors associated with prognosis). Towards answering this question, we analyzed de-identified data from a customized head and neck cancer dataset with HPV status, additional cancer treatment fields and census tract SES subset recode, from the Surveillance, Epidemiology and End Results (SEER) database that tracked patients diagnosed with HNSCC from 2010-2016. This retrospective cohort multivariate analysis utilized survival analysis methods such as Kaplan-Meier survival, hazard curves, regression, and the hypertabastic survival method, to analyze the survival time of our patients. Cross-tabulation between the registry SES tertile and race shows significance (p&lt;0.001) with the majority of blacks (58%) in the lowest socioeconomic tertile compared to 21.9% of whites. Blacks significantly differ from whites for categories age at diagnosis (p&lt;4.8E-16), subsite hypopharynx (p&lt;2.6E-4), subsite oropharynx (p&lt;1.5E-7), subsite tongue (p&lt;4.5E-4), HPV status (p&lt;3.4E-28), and presence in uninsured insurance category (p&lt;4.2E-7). Individuals in the lowest SES tertile and the uninsured groups died at higher rates than their wealthier insured peers. Proportional hazards regression reveals that across all insurance groups (Insured, Uninsured, Medicaid, and Unknown), blacks had significantly shorter survival than whites. So, regardless of whether we used SES tertile rank or insurance status as proxies for SES, and despite the idea that low SES would level the mortality playing field for black and white HNSCC patients, this preliminary analysis showed otherwise. Additionally, the association of black race with additional variables associated with poor prognosis continues to confound the interpretation of these outcomes. Determining that the racial mortality disparity exists regardless of socioeconomic tertile or insurance status can guide future research to focus on biological factors that may impact survival outcome.

Citation Format: Dana R. Marshall, Joycemary Amponsem, Billy R. Ballard, Mohammed A. El Kadmiri, Young J. Kim, Derek Wilus, Mohammad A. Tabatabai. Insurance status and racial disparities in mortality for black and white head and neck cancer patients in the United States [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1177.