Relationship Between Social Vulnerability Index and Severity of Pretreatment Swallowing Dysfunction for Oropharyngeal...

Given growing recognition that social determinants of health influence cancer outcomes and functional status, we sought to examine associations between social vulnerability, measured by CDC's Social Vulnerability Index (SVI), and pretreatment swallowing function, quantified by Modified Barium Swallow Impairment Profiles (MBSImP), in patients with oropharyngeal squamous cell carcinoma (OPSCC).

Retrospective analysis of patients at Northwestern University with pretreatment MBSImP studies.

MBSImP oral total (OT) and pharyngeal total (PT) scores were calculated, and SVI assigned to patient residential address at diagnosis. Associations between overall SVI, SVI subcomponents, clinical variables, and OT and PT scores were assessed using univariable and multivariable linear regression.

149 OPSCC patients with median age 63 years; 83.9% were male, 89.9% White, and 91.9% p16+. On univariable analysis, SVI was significantly associated with higher (worse) OT (β = 3.3; 95% CI: 1.8, 4.8; P < .001) and PT scores (β = 3.6; 95% CI: 0.75, 6.4; P = .013). After multivariable adjustment, SVI remained independently associated with increased OT scores (β = 2.3; 95% CI: 0.36, 4.2; P = .020); PT impairment was independently predicted by tumor subsite (tonsil vs. base of tongue: β = -1.8; 95% CI: -3.4, -0.28; P = .021). All four SVI domains were significantly linked to OT in univariable models.

Social vulnerability independently predicts oral-phase swallowing impairment in OPSCC patients, while tumor subsite primarily determines pharyngeal swallowing impairment. These findings highlight the need to consider social determinants in pretreatment assessment, as well as further research to clarify how social determinants impact swallowing outcomes to identify effective, targeted interventions for high-risk groups.