Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Importance: Racial disparities in head and neck cancer (HNC) are well known. Persistent health inequities exist in HNC treatment and outcomes in racial and ethnic minorities. Structural racism creates inequitable population-level risk for different health conditions, including cancer. This study is the first to review and synthesize the effects of structural racism on HNC risk factors and outcomes among racial and ethnic minority populations.
Observations: Using the PRISMA guidelines, English language studies conducted in the United States were searched in PubMed, Embase, and Scopus, and unpublished studies in ProQuest, PapersFirst, MedNar, and Open Access Theses and Dissertations from the database inception to May 6, 2024. Domains of structural racism included neighborhood and built environment, occupation and employment, health care access, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice. Articles focused on race and ancestry were also included. A total of 11,662 studies were identified. After duplicate studies were removed, 6,734 were screened resulting by two independent reviewers resulting in 38 studies meeting inclusion for full text review. Study types included were case reports, cohort studies, observational studies, and case-control studies. The synthesis of findings demonstrated that survival outcomes of HNC in racial and ethnic minority populations were associated with and compounded by neighborhood factors and socioeconomic status (SES). Race was not as impactful on survival outcomes in higher SES populations compared to lower SES, and in some studies, racial differences in survival were no longer significant after adjusting for tumor factors and SES. Survival disparities persisted in one study comparing Black and White participants even at higher SES levels. Black participants residing in areas of increased racial segregation were found to have worse overall oral cancer survival. Insurance status affected survival disproportionately in Black compared to White participants and Black participants were more likely to experience increased time to treatment and less likely to travel for treatment. Black participants demonstrated stronger estimates of association for higher intensity and duration of cigarette smoking, which is a substantial risk factor for HNC. Increased use of tobacco and alcohol at the neighborhood level contributed to increased risk of HNC in Black participants. Perceived barriers to access to care among Black males contributed to delays in seeking treatment. While most studies focused on Black versus White populations, Native Hawaiian and other Pacific Islander participants were found to be more likely to present with advanced-stage disease and had worse disease-specific survival compared to White and Asian populations.
Conclusions and Relevance: Structural racism significantly contributes to disparities in HNC treatment and outcomes experienced by racial and ethnic minority populations in the United States. Further research is needed to evaluate structural racism domains to inform multi-level interventions to eliminate inequities in HNC treatment and outcomes among racial and ethnic minority populations in the United States.