Area and Social Deprivation Indices as Predictors in Oropharyngeal Carcinoma

Introduction: Social determinants of health (SDOH) are a growing focus of clinical research in head and neck cancer. This retrospective cohort study aims to investigate area deprivation index (ADI) and social vulnerability index (SVI) as predictors of clinical severity and prognosis among oropharyngeal squamous cell carcinoma (OPSCC) patients.

Methods: Patients diagnosed with OPSCC between 2007 and 2022 at our institution were grouped into quartiles at the census tract level according to the Center for Disease Control SVI and the Neighborhood Atlas ADI. Patients with incomplete staging data were excluded. A univariable analysis utilizing Chi-Square testing and ANOVA was performed to assess the association between SVI and ADI quartiles with race, ethnicity, age, smoking status, tumor subsite, stage, p16 marker status, treatment, and recurrence. Survival stratified by ADI and SVI was evaluated with Kaplan Meier analysis.

Results: Of 493 patients treated in the study period, 452 patients had complete staging data and were included in this analysis. Most patients were white (401, 89%) and male (390, 86%). The average age was 60 + 9.5 years. Most cancers were found in the tonsil (269, 60%) and tongue base (156, 35%). Less common primary sites were the soft palate (9, 2%) and posterior pharyngeal wall (6, 1%). On univariable analysis, higher ADI percentiles were significantly associated with race (p=0.003), smoking status (p=0.001), and p16 positivity (p=0.041). Patients with higher SVI percentiles were more commonly black (p < 0.001), Hispanic/Latino (p=0.017), and were diagnosed at more advanced T stages (p=0.006). With a median follow-up of 30 months, the 3-year survival of patients included in survival analysis was 85.9% (95% CI: 81.8-90.3%). There was no difference in survival of patients with low vs high ADI or SVI on log-rank testing (p=0.10, and p=0.30 respectively).

Conclusions: Social vulnerability and area deprivation may be correlated to clinical severity and risk factors in oropharyngeal carcinoma patients such as race, ethnicity, smoking status, p16 status and T-stage.