Dying to be Screened: Exploring the Unequal Burden of Head and Neck Cancer in Health Provider Shortage Areas.

Abstract

Multiple factors contribute to disparities in head and neck cancer prevalence across the sociodemographic spectrum, including a lack of screening efforts in mostly underserved minority communities. African Americans and other ethnic minorities are at greater risk for late-stage diagnoses due to the lack of routine screenings and examinations. Advanced stage diagnosis profoundly limits treatment options, disease recovery, and survivorship. Differential access to care is frequently cited as contributing to delayed diagnosis in minority patients. Access to care is a complex concept that includes not only insurance status but also the equitable spatial distribution of health-care services. Recognizing this complexity, we explored the distribution of head and neck cancer cases seen at Grady Health System from 2010 to 2012 in order to identify geographic trends in disease prevalence compared to the distribution of oral health-care providers at the zip code level. We identified 53 cases of head and neck cancer spread across 36 zip codes primarily in the metropolitan Atlanta region. Geographic information systems analysis showed a spatial mismatch: increased disease prevalence and provider shortage in the mostly minority zip codes, and decreased disease prevalence and greater provider presence in the majority zip codes.