Racial Disparities in Distant Metastasis at Presentation of Head and Neck Cancer in Los Angeles County

Abstract Purpose Distant metastasis of head and neck cancer is associated with significantly worse prognosis. To improve the quality of care in our region, we sought to understand socioeconomic factors associated with distant metastasis upon presentation among the patients our institution serves. Methods Retrospective cohort analysis patients of the Los Angeles County Surveillance Epidemiology and End Results (SEER) database diagnosed with cancer of the head and neck from January 1, 2004 to December 31, 2015. Descriptive statistics were used to characterize our cohort. Multivariable logistic regression was used to identify clinical and sociodemographic factors associated with distant metastasis at presentation. Signifcance was set at p < 0.05. Results Our study population of 1,977 patients was primarily male (69.85%), white (78.00%), and had average age of diagnosis of 66.55 years (SD = 18.82 years). In multivariate logistic regression (OR, 95% CI), increased age at diagnosis (0.97, [0.96–0.99]), Black race (0.03, [0.003–0.35]), and private insured status (0.24, [0.07–0.80]) were associated with decreased likelihood of distant metastasis at presentation. There was an interaction between age at diagnosis and Hispanic ethnicity relative to White patients (1.05, [1.02–1.09]). Whereas the likelihood of presenting with distant metastasis decreased over time for non-Hispanic patients, Hispanic patients were increasingly more likely to present with distant metastasis as the age at diagnosis increased. Conclusions In Los Angeles County, older Hispanic patients who face barriers to timely healthcare may be at increased risk. As these findings are absent in larger national studies, we hope to inspire others to examine the populations they serve.