Abstract A115: Socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States

Background: There are previous studies on the impact of socioeconomic status on head and neck cancer outcomes, but it is not clear whether these factors are associated with short-term mortality as most studies on risk factors for mortality have focused on long-term mortality and clinical factors. This study aimed to quantify 90-day mortality rates and identify socioeconomic factors associated with 90-day mortality among patients with head and neck cancer. Methods: This retrospective cohort study included 260,011 patients from the National Cancer Database (2004 to 2014) ≥ 18 years with a diagnosis of head and neck cancer and treated with curative intent with a combination of either surgery, radiation, and/or chemotherapy. Our outcome of interest was any-cause mortality within 90 days of first treatment. The effects of socioeconomic factors on 90-day mortality were estimated using the Cox proportional hazards model with the following adjustments: Heaviside function for time-varying effects and Šidák correction for familywise error (multiple comparisons). A multinomial cumulative logit model estimated the likelihood of higher comorbidity scores in variables of interest. Results: There were 9,771 deaths within 90 days of treatment, yielding a 90-day mortality rate of 3.8%. Several socioeconomic factors were associated with 90-day mortality. Blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) were marginally more likely to die within 90 days of treatment. Hazard of 90-day mortality was significantly greater among patients who were uninsured (aHR = 1.71; 95% CI 1.48, 1.99) or insured by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53), compared to those with private insurance. Residence in a zip-code with lower median income was associated with greater hazard of 90-day mortality [(aHR 250 miles = 0.70; 95% CI 50, 0.99)]. In addition, farther travel distance for treatment was associated with lower comorbidity scores [(aOR 50 - 249.9 miles = 0.91; 99% CI 0.86, 0.97); (aOR >250 miles = 0.78; 99% CI 0.67, 0.92)]. Conclusions: While the 90-day mortality rate was low among this national cohort of patients with h