Statewide Social Vulnerability Index (SVI) in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma.

Abstract

Objectives: To investigate the association between social determinants of health, as measured by the social vulnerability index (SVI), with outcomes in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).

Methods: This study included patients from Illinois with HPV-OPSCC from 2007 to 2022. State-level SVI measured neighborhood-level disadvantage and associations between SVI and clinicodemographic factors, clinical presentation, and outcomes were analyzed using logistic regression for advanced preliminary staging, while survival and recurrence were assessed within the framework of a Cox proportional hazards model.

Results: Higher overall (high vulnerability) and racial-ethnicity SVI scores were significantly associated with increased odds of advanced clinical staging (OR=1.12, P=0.041; OR=1.16, P=0.026) on univariable analysis. Multivariable analysis showed that minority race was significantly associated with advanced clinical staging (OR=5.50, P<0.001). Overall survival was significantly associated with insurance payer type and age, where Medicaid/uninsured status had higher mortality compared with Medicare in both the univariable and multivariable setting (HR=4.47, P=0.006; HR=7.93, P=0.019). The same held for age, where increased age at diagnosis was significantly associated with higher mortality (HR=1.07, P<0.001; HR=1.10, P<0.001). Recurrence-free survival was significantly associated with age (HR=1.04, P=0.004) and payer type, with Medicaid/uninsured patients having 4 times the hazard of patients with Medicare (HR=4.16, P=0.009).

Conclusions: Higher overall and racial ethnicity SVI may be associated with advanced clinical staging upon presentation. Individual factors such as race, age, and insurance status are significantly associated with patient prognosis.