Abstract 1951: Combining diverse data sources to examine disparities in stage at diagnosis among adults with oral cancer in the United States
Authors: Chawla Sana , Satagopan Jaya M. 
Published: April 2023

Abstract
Background: The objective of this study is to examine the effects of county-level socioeconomic and healthcare access factors on stage at diagnosis of oral cancer in the United States by combining data from disparate sources.
Methods: We abstracted oral cancer data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries research database. These data included tumor characteristics, demographics, and county of residence of cases. We abstracted county-level socioeconomic variables from the American Community Survey (ACS), county-level smoking prevalence from the Behavioral Risk Factor Surveillance System (BRFSS), and county-level healthcare resource data from the Area Health Resource File (AHRF). The binary outcome was stage at diagnosis (distant versus localized or regional). The predictors were age category at diagnosis, sex, race/ethnicity available for individual cases, and county-level variables. We used a multilevel mixed effects analysis to assess the correlates of patient-level and county-level factors on stage at diagnosis of oral cancer in cases diagnosed between 2010 and 2016 from 612 counties.
Results: Among 54,099 patients diagnosed with oral cancer, 10954 (20.25%) had distant-stage disease. Multivariable analysis showed statistical difference in distant versus localized or regional stage at diagnosis between non-Hispanic Whites and Non-Hispanic Blacks (odds ratio [OR]: 1.872, 95% confidence interval [CI]: 1.743 - 2.0), Asians (OR: 1.762, 95% CI: 1.619 - 1.917), and Hispanics (OR: 1.380, 95% CI: 1.274 - 1.495), and between females and males (OR: 1.348, 95% CI: 1.282 - 1.427). The proportion of patients with distant stage disease also increased significantly with increasing age. In addition to patient-level characteristics, some county-level factors were also associated with distant stage at diagnosis. The proportion of patients with distant stage disease was significantly higher in counties with above-median percentage of foreign-born residents (OR: 1.157, 95% CI: 1.011 - 1.323) and above-median prevalence of ever smokers (OR: 1.123, 95% CI: 1.022 - 1.233). Of 2.18% total variability in stage at diagnosis, 0.4% was accounted for by patient-level characteristics and 0.32% by county-level characteristics, leaving 1.46% unexplained variation.
Conclusion: We see significant roles of county-level smoking and foreign-born status on the risk of distant stage at diagnosis of oral cancer. This suggests a critical need to understand the oral health practices and behaviors of immigrant populations, including their tobacco product use and oral cancer screening uptake.
Citation Format: Sana Chawla, Jaya M. Satagopan. Combining diverse data sources to examine disparities in stage at diagnosis among adults with oral cancer in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1951.