title: Measures of economic advantage associated with HPV-positive head and neck cancers among non-Hispanic black and white males identified through the National Cancer Database.
abstract: National trends show dramatic increases in the incidence of HPV-related head and neck squamous cell carcinomas (HNSCCs) among black and white males. Using cases identified through the National Cancer Data Base, we assessed factors associated with HPV 16- or 16/18 positive HNSCCs among non-Hispanic black and white males diagnosed in the U.S. between 2009 and 2013.
  
  
  
  This sample included 21,524 HNSCCs with known HPV status. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression.
  
  
  
  Compared to those with HPV-negative tumors, male patients diagnosed with HPV-positive HNSCCs were non-Hispanic white, younger at diagnosis, lived in zip-code areas with higher median household income and higher educational attainment, had private health insurance and no reported comorbidities at diagnosis. Although the risk of HPV-positive HNSCCs increased with measures of higher area-level socioeconomic status, the effect was stronger for non-Hispanic black males (RRAdjusted=1.76, 95% CI 1.49-2.09) than for whites (RRAdjusted=1.12, 95% CI 1.08-1.16). The peak age for diagnosis of HPV-positive HNSCCs occurred in those diagnosed at 45-49 years (RRAdjusted=1.57, 95% CI 1.42-1.73). Oropharyngeal tumors were strongly associated with HPV-positivity (RRAdjusted=4.32, 95% CI 4.03-4.63). In the analysis restricted to oropharyngeal anatomic sites, similar patterns persisted.
  
  
  
  In our analysis, measures of economic advantage were associated with an increased risk of HPV-positive HNSCCs. In order to develop effective interventions, greater understanding of the risk factors for HPV-positive HNSCCs is needed among both high-risk males and their healthcare providers.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States; University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Institute for Health Research and Policy, Chicago, United States. Electronic address: cpeter1@uic.edu.
authors.forename: Caryn E
authors.initials: CE
authors.lastname: Peterson
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States.
authors.forename: Shaveta
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, United States.
authors.forename: Gina D
authors.initials: GD
authors.lastname: Jefferson
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Faith G
authors.initials: FG
authors.lastname: Davis
authors.affiliation: University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Institute for Health Research and Policy, Chicago, United States; University of Illinois at Chicago, Department of Pediatrics, Chicago, United States.
authors.forename: Marian L
authors.initials: ML
authors.lastname: Fitzgibbon
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States.
authors.forename: Sally
authors.initials: S
authors.lastname: Freels
authors.affiliation: Survey Research Laboratory, Public Administration, University of Illinois at Chicago, 412 South Peoria Street, Chicago, 60607, United States.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Johnson
authors.affiliation: University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Institute for Health Research and Policy, Chicago, United States; University of Illinois at Chicago, Department of Medicine, Chicago, United States.
authors.forename: Kent
authors.initials: K
authors.lastname: Hoskins
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States; University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, United States.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Joslin
mesh_terms: D001741:Black or African American; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D054547:National Cancer Institute (U.S.); D009959:Oropharyngeal Neoplasms / Q000821:virology*; D030361:Papillomavirus Infections / Q000821:virology*; D012307:Risk Factors; D014481:United States; D044465:White People
keywords: Economic advantage; HPV; Head and neck cancer; Human papillomavirus; Socioeconomic status