Mediators of Racial Disparities in Head and Neck Cancer Survival

To evaluate and quantify the mediation effects of neighborhood socioeconomic status (SES), insurance status, and quality of care on racial disparities in HNC survival.

Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Mediators included insurance status, SES, hospital quality, and National Comprehensive Cancer Network (NCCN) guideline-compliant care.

Black patients (HR 1.14, 95% CI 1.05-1.24) had worse OS compared with White patients after adjusting for demographic, clinical, and treatment factors. SES accounted for 49.0% (95% CI 13.1%-84.8%) of the disparity. Health insurance (commercial: 21.9% (95% CI 12.3%-38.4%), Medicaid: 19.7% (95% CI 10.1%-45.4%)), hospital quality (high-quality: 5.1% (95% CI 2.1%-9.3%), low-quality: 4.9% (95% CI 1.2%-9.8%)), and guideline-compliant care (10.9% (95% CI 3.2%-23.6%)) also mediated the disparity. Asian/Pacific Islander patients (HR 1.26, 95% CI 1.10-1.43) had worse DSS. Health insurance had a small mediation effect (commercial: 3.0% (95% CI 1.0%-6.6%), Medicaid: 5.1% (95% CI 2.1%-8.9%)), while SES, hospital quality, and guideline-compliant care did not.

SES, insurance status, and quality of care mediate racial disparities in HNC survival. These findings suggest that health system and policy interventions targeting SES, insurance reform, and quality of care may lead to reductions in HNC disparities.