title: Socioeconomic and Other Demographic Disparities Predicting Survival among Head and Neck Cancer Patients.
abstract: BACKGROUND
  The Institute of Medicine (IOM) report, "Unequal Treatment," which defines disparities as racially based, indicates that disparities in cancer diagnosis and treatment are less clear. While a number of studies have acknowledged cancer disparities, they have limitations of retrospective nature, small sample sizes, inability to control for covariates, and measurement errors.
  
  
  OBJECTIVE
  The purpose of this study was to examine disparities as predictors of survival among newly diagnosed head and neck cancer patients recruited from 3 hospitals in Michigan, USA, while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality).
  
  
  METHODS
  Longitudinal data were collected from newly diagnosed head and neck cancer patients (N = 634). The independent variables were median household income, education, race, age, sex, and marital status. The outcome variables were overall, cancer-specific, and disease-free survival censored at 5 years. Kaplan-Meier curves and univariate and multivariate Cox proportional hazards models were performed to examine demographic disparities in relation to survival.
  
  
  RESULTS
  Five-year overall, cancer-specific, and disease-free survival were 65.4% (407/622), 76.4% (487/622), and 67.0% (427/622), respectively. Lower income (HR, 1.5; 95% CI, 1.1-2.0 for overall survival; HR, 1.4; 95% CI, 1.0-1.9 for cancer-specific survival), high school education or less (HR, 1.4; 95% CI, 1.1-1.9 for overall survival; HR, 1.4; 95% CI, 1.1-1.9 for cancer-specific survival), and older age in decades (HR, 1.4; 95% CI, 1.2-1.7 for overall survival; HR, 1.2; 95% CI, 1.1-1.4 for cancer-specific survival) decreased both overall and disease-free survival rates. A high school education or less (HR, 1.4; 95% CI, 1.0-2.1) and advanced age (HR, 1.3; 95% CI, 1.1-1.6) were significant independent predictors of poor cancer-specific survival.
  
  
  CONCLUSIONS
  Low income, low education, and advanced age predicted poor survival while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). Recommendations from the Institute of Medicine's Report to reduce disparities need to be implemented in treating head and neck cancer patients.
authors.affiliation: College of Nursing, Michigan State University, East Lansing, MI, United States of America.
authors.forename: Seung Hee
authors.initials: SH
authors.lastname: Choi
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Terrell
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Scott A
authors.initials: SA
authors.lastname: McLean
authors.affiliation: Henry Ford Hospital, Detroit, MI, United States of America.
authors.forename: Tamer
authors.initials: T
authors.lastname: Ghanem
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, United States of America.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.|College of Nursing, Ohio State University, Columbus, OH, United States of America.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Duffy
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D044465:White People; D055815:Young Adult