title: Impact of African-American race on presentation, treatment, and survival of head and neck cancer.
abstract: OBJECTIVE
  To determine the associations between African American race and stage at diagnosis, receipt of definitive therapy, and cancer-specific mortality among patients with head and neck cancer.
  
  
  METHODS
  The Surveillance, Epidemiology and End Results (SEER) database was used to conduct a retrospective study on 34,437 patients diagnosed with head and neck cancer from 2007 to 2010. Multivariable logistic regression analyses were applied to determine the impact of race on cancer stage at presentation (metastatic vs. non-metastatic) and receipt of definitive treatment. Fine and Gray competing-risks regression modeled the association between race and head and neck cancer-specific mortality.
  
  
  RESULTS
  African Americans were more likely to present with metastatic cancer compared to non-African Americans (Adjusted Odds Ratio [AOR] 1.76; CI 1.50-2.07; P<0.001). Among patients with non-metastatic disease, African Americans were less likely to receive definitive treatment (AOR 0.63; CI 0.55-0.72; P<0.001). After a median follow-up of 19months, African Americans with non-metastatic disease were found to have a higher risk of head and neck cancer specific mortality (AHR 1.19; 95% CI 1.09-1.29; P<0.001).
  
  
  CONCLUSIONS
  African Americans with head and neck cancer are more likely to present with metastatic disease, less likely to be treated definitively, and are more likely to die from head and neck cancer. The unacceptably high rates of disparity found in this study should serve as immediate targets for urgent healthcare policy intervention.
authors.affiliation: Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA.
authors.forename: Gino
authors.initials: G
authors.lastname: Inverso
authors.affiliation: Harvard Radiation Oncology Program, Massachusetts General Hospital, 55 FruitStreet, Boston, MA 02114, USA.
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bruce Donoff
authors.affiliation: Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: sung-kiang_chuang@hms.harvard.edu.
authors.forename: Sung-Kiang
authors.initials: SK
authors.lastname: Chuang
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D017668:Age of Onset; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: African Americans; Head and neck cancer; Head and neck cancer specific survival; Healthcare disparities; Minority health