Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences
Editor's Note: This Manuscript was accepted for publication on July 28, 2020.
P.L.N. receives support from Bayer, Astellas, Ferring, Dendreon, Blue Earth, Genome Dx, Augmenix, Boston Scientific, Janssen, and Cota Healthcare.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
The authors would like to thank the New York University Department of Otolaryngology for their support and Binhuan Wang, PhD at the New York University Department of Population Health and Michael Ruan for their expertise and advice on data analysis.
Abstract
Objective
Race predicts overall mortality (OM) of laryngeal squamous cell carcinoma (LSCC) in the United States (US). We assessed whether racial disparities affect cancer-specific mortality (CSM) using the Surveillance, Epidemiology, and End Results (SEER) database.
Methods
Adults with LSCC from 2004 to 2015 were selected. Univariable and multivariable Cox proportional hazards and Fine-Gray competing-risks regression analysis adjusted for clinicodemographic factors defined hazard ratios (aHR).
Results
We identified 14,506 patients. The median age was 63 years. Most were male (11,725, 80.8%) and white (11,653, 80.3%), followed by Black (2294, 15.8%). Most had early-stage disease (7544, 52.0%) and received radiotherapy only (4107, 28.3%), followed by chemoradiation (3748, 25.8%). With median follow-up of 60 months, overall 3- and 5-year OM were 34.0% and 43.2%; CSM were 16.0% and 18.9%, respectively. Black patients had higher OM than white patients on univariable (HR 1.35, 95% CI, 1.26–1.44, P < .001) and multivariable (aHR 1.10, 95% CI, 1.02–1.18, P = .011) analyses. Black patients had higher CSM on univariable analysis (HR 1.22, 95% CI, 1.09–1.35, P < .001) but not on multivariable CSM analysis (aHR 1.01, 95% CI, 0.90–1.13, P = .864). On multivariable analysis, year of diagnosis, age, disease site, stage, treatment, nodal metastasis, marital status, education, and geography significantly predicted CSM.
Conclusion
On multivariable analyses controlling for sociodemographic, clinical, and treatment characteristics, Black and white patients differed in OM but not in CSM. However, Black patients presented with greater proportions of higher stage cancers and sociodemographic factors such as income and marital status that were associated with worse outcomes. Efforts to target sociodemographic disparities may contribute to the mitigation of racial disparities in LSCC.
Level of Evidence
4 Laryngoscope, 131:E1147–E1155, 2021
