Effects of Rurality, Socioeconomic Status, and Race on Head and Neck Squamous Cell Carcinoma Outcomes.

Objective: To examine how rural residence interacts with SES and race/ethnicity relative to Head and neck squamous cell carcinoma (HNSCC) treatment delay and outcomes.

Methods: The SEER database was queried for patients aged ≥18 with HNSCC. Out of 164,337 cases, 126,052 remained after exclusions for missing data. Statistical tests performed included Chi-squared tests, log-binomial regression models, and parametric accelerated failure time (AFT) models, with a significance level of α < 0.05.

Results: About 38% of patients residing in lowest SES census tracts were rural, whereas over 98% of patients from highest SES tracts were urban. Delayed treatment was associated with shorter median survival [aTR = 0.968, 95% confidence interval (CI): 0.939, 0.999]. Risk for treatment delay increased with decreasing SES and was greater for those with minoritized race/ethnicity status. Rurality was associated with a lower risk [aRR: 0.917, 95% CI: 0.892, 0.946] of treatment delays but was not predictive for patient survival (aTR: 1.019 [0.978, 1.061]). Cancer-specific mortality increased with decreasing SES and was higher in patients with minoritized race/ethnicity status.

Conclusion: Rurality was associated with decreased risk for treatment delay but not with worse survival relative to urban residence, whereas low SES and minority status remained predictive for poor outcome regardless of geographic context (level of evidence: 4). Although these findings argue against HNSCC survival deficits specific to rural populations, there remains concern regarding potential care shortfalls in rural populations not detected in this sample. Confirmatory patient-level analysis should be prioritized to optimize support along the rural/urban divide.

Level of evidence: IV Laryngoscope, 2024.