Differences of Community-Level Vulnerability Associations With Early- and Later-Onset Nasopharyngeal Cancer Prognosis in the United States.

Abstract

To assess age-related differences of community, social vulnerability associations with care and prognosis among those with nasopharyngeal carcinomas. Retrospective Cohort. United States. This retrospective cohort study on 12,480 NPC-patients from 1975 to 2017 linked with 15 county-level vulnerability measures encompassing socioeconomic status (SES), minority-language status (ML), household composition (HH), housing-transportation (HT), and a total/composite vulnerability themes were assessed via adjusted linear and logistic regression analyses stratified across age groups of 20 to 44 years (younger) and ≥45 years (older) for outcomes of survival, multimodal treatment, and advanced staging. Increased total vulnerability was associated with 45% (78.3-43.1 months) reductions in survival period among younger ages but only 22% (50.8-39.9 months) decreases among older ones. Increased total vulnerability was associated with increased chemotherapy (OR 1.17; 95% CI 1.10-1.24) and decreased external beam radiotherapy (OR 0.78; 95% CI 0.71-0.85) among younger groups compared to similar but diminished differences in chemotherapy (1.07; 1.04-1.11) and external beam radiotherapy (0.87; 0.84-0.90) for older ones. Increasing total vulnerability also showed similarly increased advanced staging across ages (younger-1.09; 1.03-1.11; older-1.09, 1.06-1.13). By magnitude, HH and SES-vulnerabilities contributed to these trends over ML and HT. Increasing social vulnerability was associated with detrimental survival and treatment NPC-trends, with younger patients experiencing substantially higher magnitude correlations compared to older adults. With these trends largely constituted by HH and SES-drivers, these results present actionable targets for prospective efforts tackling the growing concerns of early-onset NPC.