title: Effect of Payer Status on Relative Survival of Patients with Laryngeal Cancer.
abstract: BACKGROUND
  Relative survival (RS) for patients with laryngeal cancer in the US population has yet to be described. Additionally, survival of patients with laryngeal cancer has demonstrated socioeconomic and racial disparities which have not been previously examined through the lens of RS.
  
  
  METHODS
  Data on 58,814 patients with laryngeal cancer were obtained from the National Cancer Database. Patients were diagnosed between 1998 and 2006, and had at least 5 years of follow-up. Birth-, year-, age-, sex- and race-specific matched life expectancies were used to estimate expected survival. Stage-stratified RS rates were calculated with multiple factors assessed for significance. Excess mortality ratios were estimated in multivariate analysis utilizing Poisson regression.
  
  
  RESULTS
  Younger age, African-American race, uninsured or Medicaid insurance, and treatment at an academic center were all significantly associated with stage IV disease. Uninsured and Medicaid patients demonstrated decreased RS when compared to privately insured individuals. Excess mortality was markedly pronounced in the first year for patients over 50 years old with stage II-IV disease, especially for the over 75-year-old cohort.
  
  
  CONCLUSIONS
  Survival disparities for uninsured and Medicaid populations were found, with these patients exhibiting increased excess mortality. Additionally, RS calculations highlight the negative effects of increasing age on survival of patients with laryngeal cancer.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, LSU Health Shreveport, Shreveport, LA, U.S.A.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Weill Cornell Medical College, New York, NY, U.S.A.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Medicine & Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA, U.S.A.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Mills
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, LSU Health Shreveport, Shreveport, LA, U.S.A.
authors.forename: Cherie-Ann O
authors.initials: CA
authors.lastname: Nathan
authors.affiliation: Department of Medicine & Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA, U.S.A. rshi@lsuhsc.edu.
authors.forename: Runhua
authors.initials: R
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007822:Laryngeal Neoplasms / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
keywords: Laryngeal cancer; NCDB; payer status; relative survival