Inequalities in overall survival of oropharynx, oral cavity, and larynx cancers in Brazil

Abstract

Abstract Socioeconomic inequalities in the survival of head and neck cancer is a widespread concern in developing countries. In Brazil, there are severe social disparities that include access to healthcare. In this context, we investigated whether social inequalities impact the overall survival of patients diagnosed with larynx, oral cavity, and oropharynx cancers in São Paulo State (2000-2018). This hospital-based cohort study used data provided by the São Paulo Oncocentro Foundation (FOSP) in São Paulo State, Brazil. The 5-year overall survival (OS) was assessed by the Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models to calculate the hazard ratio (HR). We considered a confidence level of 95% (95%CI) to indicate statistical significance. Out of the 816,393 cases recorded in the São Paulo State, a total of 37,191 cases occurred in larynx (n = 12,095), oral cavity (n = 12,858), and oropharynx (n = 12,238). The OS was 40.3%, 31.7%, and 23.6% for larynx, oral cavity, and oropharynx cancers, respectively. In multivariable Cox regression, formal education lower than 9 years increased the risk of death in oropharynx cancers (HR = 1.11; 95%CI= 1.05; 1.17), oral cavity cancers (HR = 1.06; 95%CI= 1.01; 1.12), and larynx cancers (HR = 1.09; 95%CI= 1.03; 1.16). The public healthcare assistance has shown to be a factor for a higher risk of death by 79% for oropharynx in comparison to private healthcare assistance, adjusted by age group, gender, clinical staging, and therapy modalities (chemotherapy, radiotherapy, and surgery). In conclusion, there is a remarkable social inequality at individual level in São Paulo State that poses a challenge to public the health in order to improve the overall survival in Brazilian patients. Key messages Social inequalities reduce the overall survival in oropharynx, oral cavity, and larynx cancers in São Paulo State, Brazil. Tackling social disparities is crucial since they play an essential role in the prognosis of Brazilian patients with oropharynx, oral cavity, and larynx cancers.