Abstract A115: Socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States
Authors: Gaubatz Matthew E. , Bukatko Aleksandr R. , Simpson Matthew C. , Polednik Katherine M. , Boakye Eric A. , Varvares Mark A. , Osazuwa-Peters Nosayaba 
Published: August 2020

Abstract
Background: There are previous studies on the impact of socioeconomic status on head and neck cancer outcomes, but it is not clear whether these factors are associated with short-term mortality as most studies on risk factors for mortality have focused on long-term mortality and clinical factors. This study aimed to quantify 90-day mortality rates and identify socioeconomic factors associated with 90-day mortality among patients with head and neck cancer.
Methods: This retrospective cohort study included 260,011 patients from the National Cancer Database (2004 to 2014) ≥ 18 years with a diagnosis of head and neck cancer and treated with curative intent with a combination of either surgery, radiation, and/or chemotherapy. Our outcome of interest was any-cause mortality within 90 days of first treatment. The effects of socioeconomic factors on 90-day mortality were estimated using the Cox proportional hazards model with the following adjustments: Heaviside function for time-varying effects and Šidák correction for familywise error (multiple comparisons). A multinomial cumulative logit model estimated the likelihood of higher comorbidity scores in variables of interest.
Results: There were 9,771 deaths within 90 days of treatment, yielding a 90-day mortality rate of 3.8%. Several socioeconomic factors were associated with 90-day mortality. Blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) were marginally more likely to die within 90 days of treatment. Hazard of 90-day mortality was significantly greater among patients who were uninsured (aHR = 1.71; 95% CI 1.48, 1.99) or insured by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53), compared to those with private insurance. Residence in a zip-code with lower median income was associated with greater hazard of 90-day mortality [(aHR &lt;$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000 - $34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000 - $45,999 = 1.18; 95% CI 1.08, 1.27)], while farther travel distance for treatment was associated with decreased hazard of 90-day mortality [(aHR 50 - 249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR &gt;250 miles = 0.70; 95% CI 50, 0.99)]. In addition, farther travel distance for treatment was associated with lower comorbidity scores [(aOR 50 - 249.9 miles = 0.91; 99% CI 0.86, 0.97); (aOR &gt;250 miles = 0.78; 99% CI 0.67, 0.92)].
Conclusions: While the 90-day mortality rate was low among this national cohort of patients with head and neck cancer, there were significant sociodemographic disparities observed. Males, blacks, those uninsured, those with Medicaid or Medicare, and those living in poorer zip codes were more likely to die within 90 days of treatment, highlighting issues associated with access to care. To improve short-term head and neck cancer outcomes, these socioeconomic disparities associated with differing mortality rates among this cancer patient population need to be addressed.
Citation Format: Matthew E. Gaubatz, Aleksandr R. Bukatko, Matthew C. Simpson, Katherine M. Polednik, Eric A. Boakye, Mark A. Varvares, Nosayaba Osazuwa-Peters. Socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A115.