Abstract A015: Examination of the role of area deprivation indices on head and neck cancer survival adjusting for clinical and behavioral factors
Authors: Soppe Sarah , Gilson Mackenzie , Perera A. A. Chamila , KC Madhav , Peters Edward S. , Belile Emily , Chinn Steven , Wolf Gregory T. , Taylor Jeremy M.G. , Rozek Laura 
Published: January 2023

Abstract
Background: This study aims to evaluate the association between area deprivation and survival of head and neck squamous cell carcinoma (HNSCC) in the context of social and behavioral factors. Previously, area deprivation indices (ADIs) corresponding to decreasing neighborhood affluence have been associated with poorer survival of ovarian and lung cancer (Hufnagel et. al., 2021; Fairfield et. al., 2020). Further, neighborhood deprivation indices have been shown to be related to the survival of oropharynx cancer (Reitzel et. al., 2012). However, the relationship between area deprivation and the survival of multiple head and neck cancer sites has yet to be examined while considering the full extent of possible mediating or interacting factors, including the following: smoking, alcohol, human papillomavirus (HPV), urbanicity, and other dietary factors. Methods: We used 759 patients collected as a part of the University of Michigan Head and Neck Specialized Program of Research Excellence (UM HN-SPORE) prospective cohort study for whom we were able to assign an Area Deprivation Index (ADI) score. We calculated the ADI based on 17 census variables to describe neighborhood socioeconomics. Census block group level data was downloaded from the American Community Survey. The neighborhoods were categorized into ADI tertiles, least (Q1) to most deprived (Q3) neighborhoods. The role of ADI on disease-specific and overall survival was evaluated using Cox proportional hazards models adjusting for factors such as gender, age, body mass index (BMI), stage, site, smoking status, and, HPV status. Effect modification by comorbidity indices was also evaluated. Analyses used R studio (r-project.org).Results: Initial findings show that the hazard of head and neck cancer mortality is 1.74 (95% CI = 1.27, 2.39) times higher among the highest tertile of ADI scores relative to the lowest tertile, indicating that those in more highly disadvantaged areas had a lower survival proportion. However, after adjusting for age, stage at diagnosis, site, HPV status, BMI, and smoking status, and comorbidities the hazard ratio for was reduced to 1.12 (95% CI = 0.80, 1.58). Conclusion: Higher ADI indicative of increased area deprivation is associated with poorer survival of HNSCC. However, much of this association is accounted for by the presence of comorbidities, smoking and BMI in our cohort.
Citation Format: Sarah Soppe, Mackenzie Gilson, A. A. Chamila Perera, Madhav KC, Edward S. Peters, Emily Belile, Steven Chinn, Gregory T. Wolf, Jeremy M.G. Taylor, Laura Rozek. Examination of the role of area deprivation indices on head and neck cancer survival adjusting for clinical and behavioral factors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A015.