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.

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality–urbanicity measures alongside individual-level race–ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race–ethnicity (OR, 2.07; 95% CI, 1.68–2.54) and poor Yost SES (1.43; 1.24–1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race–ethnicity (2.74; 1.84–4.71) and of males with poor Yost SES (1.98; 1.79–2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race–ethnicity (2.50; 1.82–3.44) compared to males (2.23; 1.91–2.60); this was reversed for poor Yost SES (male, 1.92, 1.76–2.10; female, 1.60, 1.32–1.95). Surgery showed negative predictors of black race–ethnicity that displayed worsened effects in females (0.60, 0.44–0.79) versus males (0.75, 0.66–0.86). First-line radiation receipt uniquely featured negative predictors for males of black race–ethnicity (0.73; 0.62–0.86) with poor Yost SES (0.74; 0.68–0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race–ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population.