Association of Social Determinants of Health With Risk of Suicide in Head and Neck Cancer

Introduction: Patients with head and neck cancer (HNC) are at an increased risk of suicide with incidence rates that are 3 times higher compared to that of the general population. While known risk factors for suicide, such as male gender, have been shown to significantly contribute to higher suicide rates in HNC patients, not much is known about the effect of various social determinants of health as risk factors. The goal of this project is to assess the association between Social Vulnerability Index (SVI) and risk of suicide in HNC patients.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to examine patients with a documented diagnosis of HNC and their cause of death from 2000 to 2020. SVI values were obtained from the CDC based on 2020 documentation and patients were assigned to their respective SVI quartiles based on county of residence at time of diagnosis. Patients with a missing county of residence at time of diagnosis were excluded.

Results: 102,027 patients with HNC and known cause of death were identified. 589 patients had suicide as their cause of death. Among these patients, 60 were included in quartile 1 SVI (Q1 - least vulnerable), 133 in Q2, 197 in Q3, and 199 in Q4 (most vulnerable). Univariate analysis looking at SVI quartiles, sex, age, and stage of presentation resulted in statistically significant findings (p < 0.01) when compared to total deaths in HNC patients. In multivariable Cox regression analysis, patients at Q1 (least vulnerable), male, single relationship status, and younger age (younger than 65 years old) were at significantly higher risk of death by suicide.

Conclusions: HNC can impose a significant psychosocial burden on patients as evidenced by higher suicide rates in this patient population. We report an interesting association between a lower SVI and an increased risk of suicide, in addition to previously known risk factors. In particular, young male patients with a single relationship status, who come from less socially vulnerable backgrounds (as captured by SVI), are at a higher risk of suicide among HNC patients.