title: Age-standardized incidence and mortality rates of oral and pharyngeal cancer in Puerto Rico and among Non-Hispanics Whites, Non-Hispanic Blacks, and Hispanics in the USA.
abstract: BACKGROUND
  In the American region, Puerto Rico (PR) has the highest incidence of oral and pharyngeal cancer (OPC), but racial/ethnic differences have never been assessed and compared with other groups in the United States of America (USA). We compared the age-adjusted incidence and mortality rates of OPC between PR and among USA Hispanics (USH), Non-Hispanic Whites (NHW), and Non-Hispanic Blacks (NHB) to assess the burden of this cancer in PR.
  
  
  METHODS
  Analysis of the age-standardized rates (per 100,000) was performed using the direct method with the world standard population (ASR(World)) from 1998-2002. Annual percent change (APC) and Relative Risks (RR) were calculated using the Poisson regression model.
  
  
  RESULTS
  The incidence ASR(World) for men in PR was constant (APC approximately 0.0%), in contrast, a decrease was observed among NHW, NHB, and USH men, although only USH showed statistical significance (APC = -4.9%, p < 0.05). In women, the highest increase in incidence (APC = 5.3%) and the lowest decrease in mortality (APC = -1.4%) was observed in PR. The ratio of the ASR(World) showed that in all racial/ethnic groups, men had approximately 2-4 fold increased incidence and mortality risk of OPC than women (p < 0.05). Men in PR had a higher mortality risk (p < 0.05) of OPC as compared to USH, NHW, and NHB; but among women, PR showed a significant excess of mortality only as compared to USH (est. SRR = 1.82, 95% CI = 1.41, 2.33).
  
  
  CONCLUSIONS
  The overall higher incidence of OPC in men in PR as compared to USH, NHB, and NHW could be explained by the effect of gene-environment interactions. Meanwhile, the higher mortality from OPC in PR suggests limitations in the health-care access within this population. Further research is warranted to elucidate these findings.
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA. erick.suarez@upr.edu
authors.forename: Erick
authors.initials: E
authors.lastname: Suárez
authors.forename: William A
authors.initials: WA
authors.lastname: Calo
authors.forename: Eduardo Y
authors.initials: EY
authors.lastname: Hernández
authors.forename: Elba C
authors.initials: EC
authors.lastname: Diaz
authors.forename: Nayda R
authors.initials: NR
authors.lastname: Figueroa
authors.forename: Ana P
authors.initials: AP
authors.lastname: Ortiz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000208:ethnology* / Q000401:mortality; D010610:Pharyngeal Neoplasms / Q000208:ethnology* / Q000401:mortality; D011647:Puerto Rico / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*