Multi-level disparities in survival among patients diagnosed with oral cavity cancer in Texas between 1995 and 2020

Background: Multi-level factors, including demographic and neighborhood social conditions, related to disparities in oral cavity cancer (OCC) are not fully understood. We examined the association between these factors and survival outcomes among patients diagnosed with OCC. Methods: We identified 14,416 patients diagnosed with OCC from 1995 to 2020 using population-based data from the Texas Cancer Registry. Neighborhood-level social vulnerability was measured using the 2010 US Centers for Disease Control and Prevention's Neighborhood Social Vulnerability Index (CDC-SVI). We examined race and ethnicity, CDC-SVI (as sample-based quintiles), and their joint effects with survival outcomes. Results: Five-year survival probability was 38.6% (95% CI: 35.3, 42.0) for non-Hispanic Black patients, 55.1% (95% CI: 54.1, 56.0) for non-Hispanic White patients, 44.8% (95% CI: 42.9, 46.6) for patients in the most vulnerable neighborhoods, and 61.5% (95% CI: 59.6, 63.2) for patients in the least vulnerable neighborhoods. In adjusted models, Non-Hispanic Black patients (hazard ratio (HR) 1.79, 95% CI: 1.63, 1.95) and patients in the most vulnerable neighborhoods (HR 1.50, 95% CI: 1.40, 1.61) had a higher risk of all-cause mortality compared to non-Hispanic White patients and those in the least vulnerable neighborhoods, respectively. There were no racial and ethnic differences in all-cause mortality in the least vulnerable neighborhoods compared to non-Hispanic White patients (Non-Hispanic Black: HR 1.44, 95% CI: 0.95, 2.18). Conclusions: Findings underscore the importance of mitigating inequities in survival outcomes among patients with OCC and demonstrate that racial and ethnic disparities in survival outcomes were largely attenuated among patients living in the least socially vulnerable neighborhoods.