Abstract B129: Does insurance status explain the racial disparity in survival outcome seen in upper aerodigestive tract cancers in the United States?
Authors: Amponsem Joycemary G , Marshall Dana , Wilus Derek , Tabatabai Mohammad 
Published: September 2020

Abstract
Upper Aerodigestive tract (UADT) cancers are primarily squamous cell carcinomas that affect the oral cavity (hard palate, front 2/3 of tongue, gums, mucosal lining of lips and cheeks, and the floor of the mouth), oropharynx (base of the tongue, soft palate, and tonsils), hypopharynx, larynx (epiglottis and vocal cords), and the upper third of the esophagus with a five-year survival rate of 65.3% for oral cavity and pharyngeal cancers. If the cancer is detected during the localized stage, the survival rate improves to 84.4% (SEER 18 2009-2015).There have been several risk factors implicated in the pathogenesis of UADT cancers such as, male gender, smoking, alcohol use, and infection with human papilloma virus (HPV) for oropharyngeal cancers. The current literature suggests that regardless of stage people of African descent have a lower incidence of UADT cancers, but higher mortality rates compared to Caucasians. There are many proposed explanations for this paradoxical trend seen in African Americans. However, there is a paucity of research addressing this problem. We seek to understand if socioeconomic status is the underlying factor driving this disparity. We analyzed de-identified data collected from the Surveillance, Epidemiology, and End Results (SEER) program for 114,510 UADT cancer patients diagnosed from 2007-2016. We hypothesized that people who were uninsured or on Medicaid would have a life expectancy that was significantly reduced compared to those that had private insurance or Medicare regardless of race, tumor grade, gender or site of the cancer. Our study design is retrospective cohort. Our multivariate analysis model utilizes survival analysis techniques such as Kaplan-Meier survival, hazard curves and proportional hazards regression to analyze the survival time of our patients as a function of demographic and clinical variables. Survival months ranged from 0 to 119 months, with 25,122 patients experiencing death due to UADT cancers. The proportional hazards regression revealed that across all insurance groups (Insured, Uninsured, Medicaid, and Unknown) the survival time for Non-Hispanic Black People was significantly reduced compared to the other race/ethnicities (Asians, Caucasians, Hispanics (all races)) with Non-Hispanic Caucasians having the highest survival rate. Determining that the racial disparity exists regardless of insurance status, tumor grade, gender, and site of cancer can guide future researchers to focus on biological differences or other factors such as lack of access to care that underlie disease survival for UADT cancers.
Citation Format: Joycemary G Amponsem, Dana Marshall, Derek Wilus, Mohammad Tabatabai. Does insurance status explain the racial disparity in survival outcome seen in upper aerodigestive tract cancers in the United States? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B129.