Socioeconomic Disparities in Otolaryngology: No Easy Explanations, No Easy Answers

Nationally, blacks constitute 8.8% of HNSCC cases but appear to have a disproportionate burden of disease, with an incidence 47% to 65% higher than among whites. They also have higher rates of disease-specific mortality, tend to develop the disease at a younger age than whites, and present with more advanced-stage disease, the authors wrote. In the medical literature, SES factors had been proposed to explain some of these differences, but a major question related to the fact black patients often have worse survival than whites diagnosed with the same stage of disease.

Researchers looked at data from a hospital tumor registry for all adult HNSCC patients from 1985 to 2002. Various medical, demographic, and SES factors were taken into account and analyzed. A total of 1128 patients were studied, including 430 black patients.

Researchers found that black patients had worse five-year disease-specific survival rates than whites; furthermore, they had a greater incidence of alcohol abuse, higher incidence of advanced stage and inoperable disease at presentation, and were more likely to be treated nonsurgically. They were also more likely to be uninsured and live in areas associated with lower education and income levels than whites.

Although lifestyle and other SES factors seem to play a role, the researchers concluded that the data suggest that racial differences in HNSCC outcomes are primarily related to differences in access to health care.

Rhinosinusitis and SES

In the realm of allergic fungal rhinosinusitis (AFRS), research has shown that various SES factors influence both when patients present with disease, and the treatment they receive. A study of patients in South Carolina was done to investigate whether African-Americans were at higher risk for AFRS.

Researchers wanted to know whether this is a purely racial phenomenon, or were socioeconomic factors, or access to health care, factors related to this, said Rodney Schlosser, MD, Associate Professor and Director of Rhinology and Sinus Surgery in the Department of Otolaryngology-Head and Neck Surgery at the Medical University of South Carolina. There is very little epidemiologic and SES information relating to sinus disease in the medical literature.

Previous studies had already shown that demographics can affect risk, with most cases occurring in the southern and southeastern United States where the climate is warm and mold and fungus counts are high. Other studies had shown factors such as younger age, male gender, and African-American race are also linked to higher risk.

Dr. Schlosser and colleagues reviewed the records of patients who had undergone sinus surgery between 2002 and 2006. Along with information about diagnosis, treatment, insurance status, race, and sex, basic SES and demographic information was determined. Researchers did not have income information for the patients. Instead, the region or county where patients lived was used as a surrogate marker for income status. Information about poverty levels, percentage of African-Americans living in each county, and median household income was derived from data in a Department of Defense database.