Disparities in Survival of Head and Neck Cancer in the Hispanic Population: Systematic-Review and Meta-analysis.

Abstract

The Hispanic health paradox (HHP), the observation that Hispanic people in the United States often experience better health outcomes than non-Hispanic people despite having worse prognostic factors, has not been evaluated for patients with head and neck squamous cell carcinoma (HNSCC), a malignancy with marked racial disparities in outcomes. The objective of this study is to evaluate the HHP within the context of HNSCC. CINAHL, PubMed, and Scopus. Studies that compared survival between Hispanic and non-Hispanic patients with HNSCC in the United States were included. Meta-analysis of adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) was conducted to compare overall survival (OS) and cancer-specific survival (CSS) between Hispanic white (HW) and non-Hispanic white (NHW) patients with HNSCC. Of 2106 unique abstracts reviewed, 25 studies were included in the systematic review and 22 in the meta-analysis. Among the 657,185 patients in the meta-analysis, 6.9% (95% CI: 5.8%-8.3%) were of Hispanic ethnicity. HW patients had improved OS relative to NHW patients (aHR = 0.90, 95% CI: 0.86-0.94) among the 17 studies reporting OS and improved CSS relative to NHW patients (aHR = 0.87, 95% CI: 0.80-0.94) among the 4 studies reporting this outcome. HW people with HNSCC exhibit improved survival relative to NHW people with HNSCC, supporting the HHP in the context of HNSCC. Research is needed to understand the underlying mechanisms, which could provide insights into improving outcomes for all patients with HNSCC.