Head and neck cancer mortality: Unequal progress and emerging disparities.

Abstract

e13815 Background: Head and neck cancers (HNC) are often associated with significant morbidity due to their impact on essential functions such as speech, swallowing, and breathing, as well as their potential for disfigurement. Despite advances, HNC continues to present substantial challenges in terms of survival and quality of life, particularly in populations affected by healthcare disparities. This study analyzes trends in HNC mortality across race, ethnicity, and gender from 1999 to 2020, providing critical insights into these inequities. Methods: We utilized the CDC WONDER database to analyze age-Standardized Mortality Rates (ASMR) for HNC in the US from 1999 to 2020. HNC cases were identified using ICD codes C00-C14 (lip, oral cavity, and pharynx). ASMR, with 95% confidence intervals, was stratified by sex, race, and ethnicity and reported per 1,000,000 population. Comparisons were made between Hispanic and non-Hispanic populations, with non-Hispanic individuals further stratified by race. Trends over time were evaluated using JoinPoint regression analysis, and the Estimated Annual Percentage Change (EAPC) was calculated. Results: HNC ASMR steadily declined from 1999 to 2009 (EAPC -1.2, p < 0.01) but then showed a steady increase through 2020 (EAPC +0.5, p < 0.01). Hispanics saw a significant ASMR decline (-23%) compared to non-Hispanics (-3.6%). Among non-Hispanics, ASMR declined for African Americans (AA) and American Indians (AI) but rose in recent years for non-Hispanic Whites (NHW) and Asians making NHW with the highest ASMR in 2020 (27.9). Gender-based stratification showed males consistently exhibiting higher ASMR throughout the study period (1999: 41.4 vs 16.1; 2020: 39.2 vs 14.1). AA males had the highest ASMR in 1999 (75.7), but by 2020, a 46% decline left NHW males with the highest ASMR (42.1). While ASMR declined for females across all groups, AA females saw the largest reduction (-45%), whereas NHW females experienced only a slight decrease (-1.9%), making them the group with the highest ASMR in 2020 (15.5). Amongst all subtypes of HNC cancer, tongue cancer was found to have the highest ASMR throughout the study period (1999:5.9 - 2020:6.1) Conclusions: While all racial and ethnic groups saw a decline in HNC mortality, with AA experiencing the most significant reduction, the recent overall HNC ASMR increase appears driven by rising mortality among NHW. These findings highlight the urgent need for targeted efforts to understand and mitigate the factors driving rising mortality in NHW populations, reversing a trend that stands in contrast to their progress in other cancers. Race ASMR (1999 – 2020) Join-point trends: years (EAPC) *p<0.05 Overall 27.3 – 25.6 1999 – 2009 (-1.2*), 2009 – 2020 (0.5*) Hispanic 18.7 – 14.4 1999 – 2005 (-3.3*), 2005 – 2020 (-0.3) NHW 27.9 – 26.9 1999 – 2009 (-0.6*), 2009 – 2020 (1.0*) AA 44.1 – 23.9 1999 – 2020 (-2.7*) Asian 23.6 – 19.6 1999 – 2007 (-2.8*), 2007 – 2020 (0.1) AI 22.6 – 19.4 1999 – 2020 (-1.6*)