title: Severity of juvenile onset recurrent respiratory papillomatosis is not associated with socioeconomic status in a setting of universal health care.
abstract: BACKGROUND
  Juvenile onset recurrent respiratory papillomatosis (JORRP) results from HPV transmission. Cervical cancer, also transmitted via HPV, is known to be correlated with socioeconomic status (SES). This study aims to determine if an association exists between SES and severity of JORRP.
  
  
  METHODS
  Cross-sectional study of all active JORRP patients at the Hospital for Sick Children in Toronto in 2005. SES information from Hollingshead surveys, Postal walk Census data, and Low Income Cutoff Data were compared with Derkay-Wiatrak disease severity scores, peak annual surgical frequency, and age of diagnosis. Statistical analysis was performed using Spearman, Mann-Whitney, and linear regression analyses.
  
  
  RESULTS
  Twenty-one patients were surveyed. Hollingshead results were as follows: two patients (10%) were class I (major business and professional); 11 patients (52%) were class II (medium business, minor professional, technical); 4 patients (19%) were class III (skilled craftsmen, clerical, sales workers); 4 patients (19%) were class IV (machine operators, semiskilled workers); 0% were from class V (unskilled laborers, menial service workers). Interestingly, based on postal code data nine patients (45%) were below the low income cutoff as compared to the Toronto (metropolitan) and Ontario (provincial) rates of low income (17% and 14%, respectively). There was significant correlation between each of the SES measures and between disease severity measures. However, analysis of the SES measures versus disease severity measures did not demonstrate any significant relationship.
  
  
  CONCLUSIONS
  Though almost half the patients lived below the low income cutoff, this study did not demonstrate a significant correlation between socioeconomic status and severity of disease in JORRP. One possible explanation is that universal access to the Canadian health care system is able to provide support despite a large proportion of patients being socioeconomically vulnerable. A national level study is underway to further detect any relationship between SES and JORRP severity in the general population.
authors.affiliation: Hospital for Sick Children and the Department of Otolaryngology-Head and Neck Surgery (Leung, Campisi), 555 University Ave., 6th floor Elm, Toronto, Ontario M5G 1X8, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Leung
authors.forename: M
authors.initials: M
authors.lastname: Hawkes
authors.forename: P
authors.initials: P
authors.lastname: Campisi
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007182:Income; D007822:Laryngeal Neoplasms / Q000145:classification* / Q000191:economics / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000145:classification* / Q000191:economics / Q000601:surgery; D009790:Occupations / Q000145:classification / Q000191:economics; D009864:Ontario; D010212:Papilloma / Q000145:classification* / Q000191:economics / Q000601:surgery; D011203:Poverty; D012423:Rural Health; D012720:Severity of Illness Index; D012923:Social Class; D019472:Universal Health Insurance; D014504:Urban Health