Abstract
BackgroundStudies addressing social determinants of health (SDH) in head-neck melanomas (HNM) have only assessed socioeconomic factor impact but not a wider scope of SDH. ObjectiveUtilizing the Social Vulnerability Index (SVI), to assess the influence of specific SDH and their quantifiable associations with HNM-management disparities across the varied community contexts in the US. MethodsThis retrospective cohort study analyzed adults diagnosed with head-neck melanomas between 1975-2017 from the Surveillance, Epidemiology, and End Results Program (SEER) database. Results374,138 HNM in adults between 1975-2017 were assessed for disparities affiliated with increasing overall vulnerability/SVI scores and SDH-themes. For several melanoma subtypes, higher social vulnerability significantly decreased odds (lowest for amelanotic, OR 0.74; 95% CI 0.63-0.86) for indicated surgery, increased odds of indicated radiation (highest for epithelioid cell, 1.44; 1.08-1.96) and advanced staging on first-presentation (highest for acral-lentiginous, 1.13; 1.01-1.27). Household composition, followed by socioeconomic status and minority-language status contributed significantly within the overall trend. LimitationsLimitations include unknown cause of death and SVI score calculation based on county of residency. ConclusionsThis investigation highlights significant detrimental trends in HNM management with overall social vulnerability while showcasing the quantifiable associations of specific SDH-themes on HNM-disparities.
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