Abstract
BACKGROUND: Oral cavity cancer is marked by racial and ethnic disparities. We examined these differences in oral cavity cancer stage at diagnosis and whether neighborhood-level social vulnerability, a measure of susceptibility to hardship at the census tract level, modifies disparities. METHODS: We identified adults newly diagnosed with oral cavity cancer (1995-2020) from the Texas Cancer Registry. We estimated the association between stage at diagnosis and race and ethnicity using logistic regression and assessed effect modification by neighborhood-level social vulnerability. RESULTS: The sample included 12,957 reported oral cavity cancer cases, 77% non-Hispanic White, 6% non-Hispanic Black, and 14% Hispanic patients, and 47.4% late stage at diagnosis. Non-Hispanic Black [OR, 3.30; 95% confidence interval (CI), 2.81-3.88], Hispanic (OR, 2.02; 95% CI, 1.83-2.24), non-Hispanic Asian Americans, Native Hawaiians, and Pacific Islanders (OR, 1.66; 95% CI, 1.33-2.07) patients had higher odds of late stage at diagnosis compared with their non-Hispanic White counterparts. Neighborhood-level social vulnerability modified the associations on an additive scale only for non-Hispanic Black patients. Non-Hispanic Black patients living in the most (OR, 4.72; 95% CI, 3.70-6.02) but not the least (OR, 1.55; 95% CI, 0.81-2.94) vulnerable neighborhoods had higher odds of late stage at diagnosis compared with non-Hispanic White patients living in the least vulnerable neighborhoods. CONCLUSIONS: Racial and ethnic minorities were diagnosed with later-stage oral cavity cancer, and minority patients living in the most vulnerable neighborhoods had the highest odds. Addressing neighborhood-level social factors may lessen disparities. IMPACT: Understanding the underlying mechanisms driving these disparities is essential to developing effective interventions to mitigate them. See related In the Spotlight, p. 364.