title: The relationship between survival and socio-economic status for head and neck cancer in Canada.
abstract: BACKGROUND
  Human papilloma virus (HPV) is emerging as the primary cause for some head and neck cancers. The objective of this study was to investigate the association between head and neck cancer (HNC) survival and socioeconomic status (SES) in Canada, and to investigate changes in the relationship between HNC survival and SES from 1992 to 2005.
  
  
  METHODS
  Cases were drawn from the Canadian Cancer Registry (1992-2005), and were categorized into three subsites: oropharynx, oral cavity, and "other" (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period, which included three census years: 1991, 1996 and 2001. We linked cases to income quintiles (InQs) according to patients' postal codes.
  
  
  RESULTS
  Overall survival, without controlling for smoking, for oropharyngeal cancer increased dramatically from 1992-2005 in Canada. This increase in survival for oropharynx cancer was eliminated by the introduction of controls for smoking. Survival for all head and neck cancer subsites was strongly correlated with SES, as measured by income quintile, with lower InQ's having lower survival than higher. Lastly, the magnitude of the difference in survival between the highest and lowest income quintiles increased significantly over the time period studied for oropharynx cancer, but did not statistically significantly change for oral cavity cancer or other head and neck cancers.
  
  
  CONCLUSIONS
  These data confirm a significant impact of socioeconomic deprivation on overall survival for head and neck cancers in Canada, and may provide indirect evidence that HPV-positive head and neck cancers are more common in higher socioeconomic groups.
authors.forename: James Ted
authors.initials: JT
authors.lastname: McDonald
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa/The Ottawa Hospital, Suite S-3, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. sjohnsonobaseki@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Johnson-Obaseki
authors.forename: Euna
authors.initials: E
authors.lastname: Hwang
authors.forename: Chris
authors.initials: C
authors.lastname: Connell
authors.forename: Martin
authors.initials: M
authors.lastname: Corsten
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000175:diagnosis / Q000401:mortality*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000401:mortality*; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends