Importance: Prior investigations in social determinants of health (SDoH) in pediatric head and neck cancer (HNC) have only considered a narrow scope of HNCs, SDoH, and geography while lacking inquiry into the interrelational association of SDoH with disparities in clinical pediatric HNC.Objectives: To evaluate the association of SDoH with disparities in HNC among children and adolescents and to assess which specific aspects of SDoH are most associated with disparities in dynamic and regional sociodemographic contexts.Design, Setting, and Participants: This retrospective cohort study included data about patients (aged ≤19 years) with pediatric HNC who were diagnosed from 1975 to 2017 from the Surveillance, Epidemiology, and End Results Program (SEER) database. Data were analyzed from October 2021 to October 2022.Exposures: Overall social vulnerability and its subcomponent contributions from 15 SDoH variables, grouped into socioeconomic status (SES; poverty, unemployment, income level, and high school diploma status), minority and language status (ML; minoritized racial and ethnic group and proficiency with English), household composition (HH; household members aged ≥65 and ≤17 years, disability status, single-parent status), and housing and transportation (HT; multiunit structure, mobile homes, crowding, no vehicle, group quarters). These were ranked and scored across all US counties.Main Outcomes and Measures: Regression trends were performed in continuous measures of surveillance and survival period and in discrete measures of advanced staging and surgery receipt.Results: A total of 37 043 patients (20 729 [55.9%] aged 10-19 years; 18 603 [50.2%] male patients; 22 430 [60.6%] White patients) with 30 different HNCs in SEER had significant relative decreases in the surveillance period, ranging from 23.9% for malignant melanomas (mean [SD] duration, lowest vs highest vulnerability: 170 [128] months to 129 [88] months) to 41.9% for non-Hodgkin lymphomas (mean [SD] duration, lowest vs highest vulnerability: 216 [142] months vs 127 [94] months). SES followed by ML and HT vulnerabilities were associated with these overall trends per relative-difference magnitudes (eg, SES for ependymomas and choroid plexus tumors: mean [SD] duration, lowest vs highest vulnerability: 114 [113] months vs 86 [84] months; P < .001). Differences in mean survival time were observed with increasing social vulnerability, ranging from 11.3% for ependymomas and choroid plexus tumors (mean [SD] survival, lowest vs highest vulnerability: 46 [46] months to 41 [48] months; P = .43) to 61.4% for gliomas not otherwise specified (NOS) (mean [SD] survival, lowest vs highest vulnerability: 44 [84] months to 17 [28] months; P < .001), with ML vulnerability followed by SES, HH, and HT being significantly associated with decreased survival (eg, ML for gliomas NOS: mean [SD] survival, lowest vs highest vulnerability: 42 [84] months vs 19 [35] months; P < .001). Increased odds of advanced staging with non-Hodgkin lymphoma (OR, 1.21; 95% CI, 1.02-1.45) and retinoblastomas (OR, 1.31; 95% CI, 1.14-1.50) and decreased odds of surgery receipt for melanomas (OR, 0.79; 95% CI, 0.69-0.91) and rhabdomyosarcomas (OR, 0.90; 95% CI, 0.83-0.98) were associated with increasing overall social vulnerability.Conclusions and Relevance: In this cohort study of patients with pediatric HNC, significant decreases in receipt of care and survival time were observed with increasing SDoH vulnerability.

Objective: To investigate the association of social determinants of health (SDoH) in squamous cell carcinoma of the tongue in the United States and to evaluate the real‐world contribution of specific disparities.Study Design: Retrospective cohort study.Setting: United States.Methods: The Centers for Disease Control and Prevention‐Social Vulnerability Index (SVI) and National Cancer Institute‐Surveillance, Epidemiology, and End Results Program database were used to study 62,103 adult tongue squamous cell carcinoma patients from 1975 to 2017. Regression analysis assessed trends in months of follow‐up and survival across social vulnerability and 4 subcategories of social vulnerability.Results: As overall SVI score increases (increased social vulnerability), there is a significant decrease in the average length of follow‐up (22.95% decrease from 63.99 to 49.31 months; P < .001) across patients from the lowest and highest social vulnerability groups. As overall SVI score increases, there is a significant decrease in the average months of survival (28.00% decrease from 49.20 to 35.43 months; P < .001). There is also a significantly greater odds ratio (OR = 1.05; P < .001) of advanced cancer staging upon presentation at higher SVI scores. Patients with higher SVI scores have a lower OR (0.93; P < .001) of receiving surgery as their primary treatment when compared to patients with lower SVI scores. Patients with higher SVI scores also have a significantly greater OR (OR = 1.05; P < .001) of receiving chemotherapy as their primary treatment when compared to patients with lower SVI scores.Conclusion: Increased social vulnerability is shown to have a detrimental impact on the treatment and prognosis of patients with squamous cell carcinoma of the tongue.

Background: As thyroid cancer (TC) incidence rises, it is increasingly valuable to recognize disparities in treatment and diagnosis. Prior investigations in social determinants of health are limited to pediatric populations or studies looking at single factors such as race or environmental influences. Utilizing the CDC-Social Vulnerability Index (SVI) and SEER-patient database, to assess the amalgamated, real-world influence of varied social determinants of health (SDoH) and their quantifiable impact on TC-disparities across the United States (US). Methods: In a retrospective cohort study, 199,340 adult TC patients from 1975-2017 were assessed for significant regression trends in months of follow-up/surveillance, survival, late-staging, and treatment receipt across TC-subtypes with increasing overall-social vulnerability, as well in 15 SDoH-variables regarding socioeconomic status (SES), minority-language status (ML), household-composition (HH), and housing-transportation (HT) across all United States (US) counties while accounting for sociodemographic-regional differences. Results: With increasing overall social vulnerability, decreases in months of follow-up were observed with patients with papillary, follicular, medullary, oncocytic, and anaplastic TC (p=0.001). Comparing lowest to highest-vulnerability cohorts, relative decreases in months-surveillance ranged from 55.6% (14.5 to 6.5 months) with anaplastic to 17% (108.6 to 90.2) with oncocytic. SES followed by HH & HT contributed to these overall trends. Similar survival decreases occurred across all TC, ranging from 55.9% (9.6 to 4.2) with anaplastic to 28.3% (97 to 69.5) with oncocytic, mainly contributed by ML and HT. Increasing overall vulnerability was associated with increased odds of advanced-staging for papillary (OR, 1.07; 95% CI, 1.03-1.12) and decreased odds of indicated treatment via surgery (lowest, medullary: 0.91; 0.84-0.99), radiation therapy (lowest, anaplastic: 0.88; 0.82-0.93), and chemotherapy (lowest, oncocytic: 0.81 0.67-0.98) were observed; ML, HT followed by SES were contributors to these overall vulnerability trends. Conclusions: Our results show significant detriments in TC care & prognosis in the US with increasing overall social vulnerability while identifying which SDoH quantifiably contribute more to disparities in interrelational, real-world-like contexts.

Study Design: Retrospective cohort study Objective: The aim of this study was to determine the incidence of and risk factors for persistent opioid use after elective cervical and lumbar spine procedures and to quantify postoperative healthcare utilization in this patient population. Methods: Patients were retrospectively identified who underwent elective spine surgery for either cervical or lumbar degenerative pathology between November 1, 2013, and September 30, 2018, at a single academic center. Patients were split into 2 cohorts, including patients with and without opioid use at 180-days postoperatively. Baseline patient demographics, underlying comorbidities, surgical variables, and preoperative/postoperative opioid use were assessed. Health resource utilization metrics within 1 year postoperatively (ie, imaging studies, emergency and urgent care visits, hospital readmissions, opioid prescriptions, etc.) were compared between these 2 groups. Results: 583 patients met inclusion criteria, of which 16.6% had opioid persistence after surgery. Opioid persistence was associated with ASA score ≥3 (P = .004), diabetes ( P = .019), class I obesity ( P = .012), and an opioid prescription in the 60 days prior to surgery ( P = .006). Independent risk factors for opioid persistence assessed via multivariate regression included multi-level lumbar fusion (RR = 2.957), cervical central stenosis (RR = 2.761), and pre-operative opioid use (RR = 2.668). Opioid persistence was associated with higher rates of health care utilization, including more radiographs ( P < .001), computed tomography (CT) scans (.007), magnetic resonance imaging (MRI) studies ( P = .014), emergency department (ED) visits (.009), pain medicine referrals (P < .001), and spinal injections ( P = .003). Conclusions: Opioid persistence is associated with higher rates of health care utilization within 1 year after elective spine surgery.

Key point: Social determinants of health interactively influence sinonasal cancer care and prognosis. Housing‐transportation and socioeconomic status showed the largest associations with disparities. The social vulnerability index can reveal the social determinants of sinonasal cancers.