Head and Neck Cancer Survival Disparities by Race and Rural-Urban Context

Background: This study aims to examine the relationship between race and rural-urban context in head and neck cancer (HNC) survival and determine factors that potentially drive this disparity. Methods: Using the National Cancer Database from 2004 to 2015, we identified a retrospective cohort of 146,256 patients with HNC. Kaplan-Meier survival curves and the Cox proportional hazards regression were used to calculate adjusted HRs. Results: Median survival by patient subgroup was as follows: White urban [67 months; 95% confidence interval (CI), 66.0-67.9], White rural (59.1 months; 95% CI, 57.2-60), Black urban (43.1 months; 95% CI, 41.1-44.5), and Black rural (35.1 months; 95% CI, 31.9-39.0). The difference in 5-year survival, stratified by rural-urban context, was greater among Black patients [D restricted mean survival time (DRMST) 0.18; 95% CI, 0.10-0.27] than White patients (DRMST 0.08; 95% CI, 0.06-0.11). In the univariate Cox proportional hazards analysis with White urban patients as reference group, Black rural patients had the worst survival (HR, 1.45; 95% CI, 1.43-1.48; P < 0.001), followed by Black urban patients (HR, 1.29; 95% CI, 1.28-1.30; P < 0.001), and White rural patients (HR, 1.08; 95% CI, 1.07-1.09; P < 0.001). This disparity persisted when controlling for demographic, socioeconomic, and clinical factors. Conclusions: Black patients with HNC, specifically those living in rural areas, have decreased survival. Survival differences by rural-urban status are greater among Black patients than White patients. Impact: We have shown that race and rural-urban status impact HNC survival outcomes. Our findings will help future researchers to better frame approaches to address this disparity.