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Head and Neck Surgery

(214) Geographical Comparison Between HNC Incidence and Distribution of Otolaryngologists

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Ahmad Odeh, BS

    Medical Student
    Saint Louis University School of Medicine
    Columbus, Ohio, United States

    • Senior Author(s)

  • SM

    Sean T. Massa, MD

    Associate Professor
    Saint Louis University School of Medicine
    Saint Louis, Missouri, United States

    • Co-Author(s)

  • Hank Ideker, MD

    Resident
    Saint Louis University School of Medicine
    St Louis, Missouri, United States

  • AM

    Angela Mazul, PhD

    Washington University of St. Louis, USA

Disclosure(s):
Ahmad Odeh, BS: No relevant relationships to disclose.
Sean T. Massa, MD: No relevant relationships to disclose.
Hank Ideker, MD: No relevant relationships to disclose.


Introduction: While there has been extensive research elucidating population disparities in relation to stage of Head and Neck Cancer (HNC) diagnosis, treatment, and survival, there has been much less attention on incidence disparities and factors increasing a population’s risk of developing disease in the first place. We seek to assess the geographic distribution of HNC incidence, compare the incidence to the distribution of otolaryngologists, and assess county-level factors associated with higher rates of head and neck cancer to determine the county-level geographic variation of HNC incidence in the United States compared to geospatial risk factors and the otolaryngology workforce.

Methods: This was a retrospective cohort database study that analyzed United States county-level HNC cases from 2010-2016. The Surveillance Epidemiology and End Result (SEER), Area Health Resource File (AHRF), and American Community Survey (ACS) databases were queried for HNC cases, provider demographic data, and county demographic data, respectively. The primary outcome measurement was county-level incidence rate. Multivariate analysis was performed for county variables to identify risk factors associated with higher incidence.

Results: The otolaryngology workforce was generally inversely related to the county level incidence. Compared to counties with no Otolaryngologist, those with 1-10 had a 19.6% (95% CI: 17.6-21.7%) lower incidence, and those with 11 or more had a 41.5% (39.7-43.4%) lower incidence. Significant county-level risk factors for increased incidence included higher mean age (3.68% increase in cases, CI: 3.46-3.89%), white (1.71%, CI: 1.08-2.35%) and black (1.20%, CI: 0.40-2.00%) race, and higher percentage of smokers (1.36%, CI: 1.17-1.55%) in the population. Sensitivity analysis for oropharyngeal cancer revealed similar risk factors, but a greater effect size of white race (5.91%, CI: 4.37-7.46%).

Conclusions: The distribution of otolaryngologists is inversely related to HNC incidence and may currently be inadequate to address the rising incidence of HNC in certain populations.