(0731) Socioeconomic Disadvantage Impacts Stage at Presentation for Head and Neck Squamous Cell Carcinoma

Introduction: Community-level demographics, including distance to tertiary care centers and area-deprivation index (ADI), have been shown to negatively impact patient care. The goal of our study is to assess how these factors impact patients with head and neck squamous cell carcinoma (HNSCC).

Methods: A retrospective review of all patients presenting to our institution with HNSCC from 2022-2023 was performed. Demographics including age, race, sex, ADI, and distance to tertiary care center were collected. Primary outcome of interest was initial stage at presentation.

Results: Of the 368 patients included, 220 (59.8%) presented with early-stage (I/II) disease and 148 (40.2%) presented with late-stage (III/IV) disease. On bivariate analysis, male sex (p=0.002), Caucasian race (p=0.017), history of alcohol use (p=0.037), and HPV-positive tumors (p < 0.001) were associated with early-stage diagnosis. Smoking history (p < 0.001) and high ADI index (p=.005) were associated with late-stage diagnosis. On multivariate logistic regression, alcohol use was associated with early-stage disease (OR 0.05; 95% CI 0.28-0.89; p=0.01) while HPV-negative tumors (OR 13.26; 95% CI 7.01-25.07; p< 0.001) and high ADI quartile (OR 3.48; 95% CI 1.60-7.55; p=0.002) were associated with late-stage diagnosis. ADI was a significant predictor of late-stage diagnosis on ANOVA (p=0.008), particularly when comparing HPV status (p=0.001 vs. p=0.053). Distance to tertiary care center did not differ between early and late-stage groups.

Conclusions: Residing in socioeconomically disadvantaged areas is associated with a late-stage of presentation for HNSCC, irrespective of distance to tertiary care center. Targeted intervention to improve access to health care is necessary to mitigate the effects of socioeconomic inequalities.