title: Comorbidity and survival of elderly head and neck carcinoma patients.
abstract: BACKGROUND
  Alcohol and tobacco, the primary etiologic agents for head and neck carcinoma (HNCA), cause other chronic diseases and may contribute to the high prevalence of comorbid conditions and generally poor survival of persons with HNCA.
  
  
  METHODS
  The authors explored the prognostic role of comorbidity in persons with HNCA using Health Care Finance Administration Medicare (HCFA) files linked with the appropriate files of the Surveillance, Epidemiology, and End Results (SEER) Program. The Charlson comorbidity index was applied to in-patient data from the HCFA files. The SEER data were used to ascertain survival and identify persons with HNCA diagnosed from 1985 to 1993 (n = 9386).
  
  
  RESULTS
  In a proportional hazards regression model adjusted for age and historic stage at diagnosis, race, gender, marital status, socioeconomic status, histologic grade, anatomic site, treatment, and pre-1991 diagnosis, Charlson index scores of 0, 1, and 2+ had estimated relative hazards (RHs) with 95 confidence intervals (CIs) of 1.00, 1.33 (95% CI, 1.21-1.47), and 1.83 (95% CI, 1.64-2.05), respectively (P value for trend < 0.0001). The adjusted RH for a Charlson index score of 1 or more compared with 0, using stratified models, was found to be greater in whites (RH, 1.55; 95% CI, 1.43-1.67) than blacks (RH, 1.24; 95% CI, 0.96-1.60), local (RH, 1.72; 95% CI, 1.50-1.96) versus distant stage (RH, 1.25; 95% CI, 1.00-1.56), and age 65-74 years (RH, 1.53; 95% CI, 1.38-1.69) versus age 85+ years (RH, 1.42; 95% CI, 1.09-1.84).
  
  
  CONCLUSIONS
  This study establishes comorbidity as a predictor of survival in an elderly HNCA population and lends support to the inclusion of comorbidity assessment in prognostic staging of patients with HNCA diagnosed after 65 years of age.
authors.affiliation: Department of Oral Health Care Delivery, School of Dentistry, University of Maryland, Baltimore, Maryland, USA. BCR001@dental.umaryland.edu
authors.forename: B C
authors.initials: BC
authors.lastname: Reid
authors.forename: A J
authors.initials: AJ
authors.lastname: Alberg
authors.forename: A C
authors.initials: AC
authors.lastname: Klassen
authors.forename: J M
authors.initials: JM
authors.lastname: Samet
authors.forename: R G
authors.initials: RG
authors.lastname: Rozier
authors.forename: I
authors.initials: I
authors.lastname: Garcia
authors.forename: D M
authors.initials: DM
authors.lastname: Winn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000401:mortality; D008297:Male; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000401:mortality; D010610:Pharyngeal Neoplasms / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program; D014481:United States / Q000453:epidemiology