title: Sociodemographic disparities in choice of therapy and survival in advanced laryngeal cancer.
abstract: OBJECTIVE
  To determine if sociodemographic factors are associated with treatment choice and survival in patients with advanced stage laryngeal cancer in the U.S.
  Population-based, non-concurrent cohort study of 5381 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma from 1992-2009. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  METHODS
  Choice of therapy (surgical vs. non-surgical) and disease-specific survival (DSS).
  
  
  RESULTS
  Age ≥60 years (odds ratio [OR]=0.78; 95% CI, 0.70-0.88) and more recent year of diagnosis (OR=0.89; 95% CI, 0.87-0.90) decreased the odds of receiving surgical therapy, while residing in a county with low median household income (OR=1.36; 95% CI, 1.17-1.57) increased the odds of receiving surgical therapy. Age ≥60 years (hazard ratio [HR]=1.45; 95% CI, 1.33-1.59) and Black race (HR=1.14; 95% CI, 1.02-1.27) were negatively associated with DSS, while female sex (HR=0.81; 95% CI, 0.72-0.90) and married status (HR=0.69; 95% CI, 0.63-0.75) were positively associated with DSS.
  
  
  CONCLUSIONS
  For patients with advanced laryngeal cancer, younger age and residing in a low-income county increase the likelihood of receiving surgical therapy. Female sex and married status provide a survival benefit, while Black race appears to be a negative prognostic factor. This highlights the impact of sociodemographic factors on treatment strategies and outcomes and highlights areas for further research on health disparities.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Alok T
authors.initials: AT
authors.lastname: Saini
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: uchechukwu.megwalu@mountsinai.org.
authors.forename: Uchechukwu C
authors.initials: UC
authors.lastname: Megwalu
mesh_terms: D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology