Social Vulnerability Associations With Hypopharyngeal Carcinoma Treatment and Prognostic Disparities.

OBJECTIVES

Prior studies investigating the impacts of social determinants of health (SDoH) on hypopharyngeal cancer have only assessed the impact of individual factors on patient outcomes. This study uses the CDC's Social Vulnerability Index (SVI) and a national patient cohort to examine how the interrelational influence of SDoH affect hypopharyngeal cancer prognosis, treatment, and follow-up.

METHODS

This retrospective cohort study analyzed patients from 1975 to 2017 with a diagnosis of hypopharyngeal carcinoma in the NCI-SEER database. Net social vulnerability and its contributions from 15 SDoH variables were ranked and scored across all US counties, yielding a SVI. SVI scores were matched to the patient's county of residence, and univariate linear regressions were performed on the length of care and prognosis, while univariate logistic regressions were performed on advanced staging at presentation and treatment modalities across SVI quintiles.

RESULTS

Across 16,038 hypopharyngeal cancer patients, there was a significant 22.3% (35.41-27.50 months) decrease in survival time and a 16.6% (40.00-33.36 months) decrease in surveillance time between the lowest and highest overall-social vulnerability groups. Patients with greater vulnerability were more likely to have advanced staging at presentation and to receive chemotherapy, but less likely to receive surgery or radiation, with each treatment being differentially associated with vulnerability factors.

CONCLUSION

This study on SDoH in adults with hypopharyngeal carcinoma found significant declines in care and prognosis with higher social vulnerability, along with specific associations across SDoH themes, underscoring the need for targeted public health interventions to mitigate these disparities and improve cancer care equity.

LEVEL OF EVIDENCE: 3.