Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Head and neck carcinoma (HNC) poses a significant burden worldwide, with disparities in incidence and survival among racial and ethnic groups. While differences in HNC outcomes between Black and White populations are well-documented, disparities among other racial/ethnic groups are understudied. Previous studies have suggested better HNC outcomes for Asian individuals compared to White individuals, but current monolithic data categorization of the Asian population can mask potential disparities among its diverse subgroups. Of note, South Asian individuals make up the largest Asian subgroup in the United States (US) and experience a high prevalence of oral cancer. The goal of this study was to compare HNC stage at diagnosis and survival outcomes between South Asian individuals, Other Asian individuals, and non-Hispanic White individuals in the US.
Methods: This is a retrospective population-based cohort studying utilizing the National Cancer Institute’s SEER Research Plus 17 databases. Patients above age 18 who were diagnosed with squamous HNC between 2004-2020 were included in the study. Race/ethnicity were categorized as South Asian (Asian Indian or Pakistani), Other Asian (Chinese, Filipino, Japanese, Korean, Hmong, Kampuchean, Thai, Laotian, and Vietnamese), and non-Hispanic White. We assessed the association of race/ethnicity with advanced stage disease (Stage III/IV vs I/II) and survival using unadjusted and adjusted logistic regression models and Cox proportional hazards regression models, respectively. Adjusted models covariates included demographic variables such as age, sex, marital status, and socioeconomic status (Yost index quintile), and clinical variables including surgery, radiation, chemotherapy, and AJCC stage.
Results: A total of 93,355 patients met our inclusion criteria, with 1,078 South Asian, 3,181 Other Asian, and 88,896 non-Hispanic White individuals. Adjusted logistic regression models showed that South Asian individuals had higher risk of advanced stage at diagnosis (OR = 1.43, 95% CI 1.26 to 1.64) than Other Asian (OR = 1.12, 95% CI 1.04 to 1.21) and non-Hispanic White individuals. Adjusted Cox regression models showed that South Asian individuals had worse overall survival (HR = 1.12, 95% CI 1.01 to 1.24) than Other Asian (HR = 0.90, 95% CI 0.86 to 0.95), and non-Hispanic White individuals. South Asian individuals also had worse disease-specific survival (HR = 1.31, 95% CI 1.17 to 1.47) than Other Asian (HR = 1.02, 95% CI 0.96 to 1.09), and non-Hispanic White individuals.
Conclusion: This study suggests that South Asian individuals with HNC are more likely to present with advanced stage disease at diagnosis, and have worse survival compared to Other Asian and non-Hispanic White individuals. This study highlights the importance of disaggregating Asian ethnic groups when assessing racial and ethnic disparities in HNC outcomes. Further investigation is needed to understand the drivers of poor HNC outcomes among the South Asian population.