Individual and community-level social determinant impact on HPV-differentiated nasopharyngeal carcinoma disparities in the USA.

Nasopharyngeal carcinomas (NPC) are malignancies that have seen growing burdens with human papilloma virus (HPV) infection. This investigation aims to characterize social determinant factor of health (SDoH) differences across HPV-differentiated NPC across the USA. NPC-patients with confirmed-HPV status between 2010 and 2018 from the Surveillance-Epidemiology-End Results (SEER) database were analyzed by cox-proportional and logistic regressions of age, sex, race-ethnicity, census-level rurality-urbanicity, and census-level Yost-Socioeconomic Status (SES)-Index measures to assess mortality, staging, and delayed-treatment differences. Among 820-HPV( -) and 402-HPV(+) NPCs, both NPC-cohorts displayed reduced overall mortality risk with younger age (HR 0.56, 95% CI 0.38-0.81; HR 0.57, 0.45-0.73) and higher risk with male sex (HR 1.71, 95% CI 1.11-2.64; HR 1.42, 95% CI 1.07-1.87). For HPV(-) only, Hispanic (HR 0.51, 95% CI 0.32-0.82) and Asian ethnicities (HR 0.44, 95% CI 0.33-0.58) reduced overall mortality risk, while low Yost-SES-Index increased it (HR 1.44, 1.14-1.87). For HPV( -) only, delayed treatment occurred with lower Yost-SES-Index (OR 1.97, 95% CI 1.16-3.42). Using the Yost-SES-Index and other individual/census-level SDoH, multilevel SDoH-analyses of HPV-differentiated NPC-patients display vast prognostic and treatment differences based on HPV-status. These present specific targets to prospectively and strategically address drivers of disparity with limited public health resources.

Duke Scholars

Author Nosayaba Osazuwa-Peters Head & Neck Surgical Oncology