Disparities in rural and urban outcomes in populations with human papillomavirus–associated oropharyngeal cancers

Importance

There is a need to understand how the increasing rate of HPV-positive oropharyngeal cancers may affect underresourced populations.

Purpose

To investigate possible disparities in survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.

Design

Our retrospective cohort study utilized the Surveillance, Epidemiology, and End Results (SEER) Pharyngeal Cancer with HPV Status Database from 2006 to 2018.   Cox proportional hazard models and Kaplan–Meier curves were employed to evaluate the differences in overall survival and cause-specific mortality.

Setting

SEER data used in this study originate from a set of regional cancer registries located across the country.

Participants

Patients diagnosed with HPV-associated oropharyngeal cancer from 2006 through 2018 in the SEER HPV status database.

Main Outcome(s) and Measure(s)

The difference in overall survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.

Results

A total of 13,294 patients were included in our study, most of whom lived in urban counties (88.5%, n = 11,766), had a mean age of 60.6 years (SD = 9.6), and had a primary tumor site located in the tonsil (47.6%, n = 6328). Rural communities had a higher likelihood of all-cause mortality (hazard ratio [HR] 1.14, 95% confidence interval [CI], 1.02–1.29) compared to their urban counterparts. Additionally, rural residents had a higher probability of cause-specific mortality (HR 1.15, 95% CI, 1.01–1.32) compared to their urban counterparts.

Conclusions

Patients with HPV-associated oropharyngeal cancer who reside in rural areas were more likely to die when compared to their urban counterparts. More research is needed to determine the best way to mitigate this disparity.