Racial Disparities in Head and Neck Cancer: It's Not Just About Access

Russell A Whitehead, Evan A Patel, Jeffrey C Liu, Mihir K Bhayani

Research output: Contribution to journalReview articlepeer-review

Abstract

OBJECTIVE: Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC.

DATA SOURCES: A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications.

REVIEW METHODS: Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent.

RESULTS: Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes.

CONCLUSION: Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.

Original languageEnglish
Pages (from-to)1032-1044
Number of pages13
JournalOtolaryngology - Head and Neck Surgery
Volume170
Issue number4
DOIs
StateE-pub ahead of print - Dec 23 2024

Keywords

  • head and neck cancer
  • health care disparities
  • literature review
  • Ethnicity
  • White
  • Black or African American
  • United States
  • Humans
  • Healthcare Disparities
  • Head and Neck Neoplasms/therapy
  • Hispanic or Latino

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