Population analysis of socioeconomic status and otolaryngologist distribution on head and neck cancer outcomes.

Abstract

The relationship between clinical outcomes and geographic determinants is not well known for head and neck cancer. Socioeconomic status (SES) factors and the distribution of health care resources might impact outcomes. Head and neck cancer cases in the Surveillance, Epidemiology, and End Results (SEER) database were studied. Patient-level prognostic factors were identified from the SEER, and county-level factors were identified from the Area Health Resource File. Stage at presentation and observed survival were the outcomes of interest, with predictive factors identified by multivariate logistic and Cox proportional hazards regression. On multivariate analysis, tumor site, sex, race, marital status, rural residence, and county poverty level predicted stage at presentation. Sex, race, marital status, county-level poverty, and number of otolaryngologists predicted observed survival. Adverse county-level SES predicted advanced cancer stage at presentation and diminished observed survival. SES was a stronger predictor of patient outcomes than rurality or number of otolaryngologists.