Author(s)
Govind S. Bindra, MS
David Jun Fei-Zhang, BA
Daniel Chelius, MD
Jeff Rastatter, MD MS
Anthony Sheyn, MD
Affiliation(s)
University of Tennessee Health Science Center;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to demonstrate the utility of the social vulnerability index for assessing varied social determinant impacts on prognostic and care level factors in interactional, sociodemographic contexts in the United States.
Objectives: To determine to what degree social determinants of health (SDH) are linked to diagnostic, staging, treatment, and outcome disparities among salivary gland cancer (SGC) patients across the United States.
Study Design: We used the CDC Social Vulnerability Index (SVI) to determine the impact of varied SDH and their collective influence on diagnosis, staging, treatment, and outcome of adults with SGC across the United States.
Methods: In this retrospective cohort study, we identified 24,775 SGC patients' SEER patient data from 1975-2017 and vulnerability scores from the SVI, and matched scores to patients based on county of residence at time of diagnosis.
Results: Increasing total SVI score (i.e., increased social vulnerability) revealed substantial decreases in months surveyed (28.01%-39.89%) and months survival (32.97%-47.88%) for parotid, submandibular, and other salivary gland (p<0.001) primaries; and months surveyed (3.38%-33.77%) and months survival (19.53%-52.35%) for disease classes of acinar cell neoplasms, adenocarcinomas, complex mixed and stromal neoplasms, epithelial neoplasms, mucoepidermoid neoplasms, squamous cell neoplasms, and unspecified neoplasms (p<0.028 at most). Significant decreases in months surveyed and survival were also observed for these sites and disease classes with increasing socioeconomic status, minority language, household composition, and/or housing transportation subscores. Moreover, increasing total SVI score showed significantly increased odds of adenocarcinoma patients receiving an advanced staging diagnosis (OR=1.12, 95% CI 1.07-1.17) and chemotherapy (OR=1.12, 95% CI 1.06-1.18) while showing significantly decreased odds of primary surgery (OR=0.95, 95% CI 0.90-1.00) or radiation (OR=0.95, 95% CI 0.91-0.98).
Conclusions: Our results show significant decreases in overall care and prognosis of SGC in the U.S. with increasing SVI scores while identifying which SDH contribute more to these disparities.