Abstract
BACKGROUND: Head and neck cancer (HNC) caused substantial morbidity and mortality. Despite advances in treatment modalities, the evolving burden and risk factor profiles of head and neck cancer may contribute to escalating health inequalities. The primary objective of this study is to quantitatively evaluate the degree of SDI-related health inequalities in head and neck cancer and to analyze the evolution of these health inequality trends between 1992 and 2021. METHODS: Using Global Burden of Disease 2021 data, we extracted disability-adjusted life years (DALYs), DALY rates and age-standardized DALY rates (ASDR) for HNC and its five subtypes across 204 countries/territories (1992-2021). Temporal trends stratified by sex and Sociodemographic Index (SDI) levels were assessed using estimated annual percentage change (EAPC) modeling. Socioeconomic health inequalities were further measured through complementary metrics: the Slope Index of Inequality (SII) and Concentration Index (CIX). RESULTS: From 1992 to 2021, the global ASDR for HNC declined from 228.1 to 179.37 per 100,000 (EAPC: -0.95, 95% CI: -1.05 to -0.84). The low-middle SDI region exhibited the highest ASDR (294.46 per 100,000), while the high SDI region recorded the lowest ASDR (107.97 per 100,000). The CIX indicated a progressive deterioration, decreasing from - 0.11 (95% CI: -0.15 to -0.08). in 1992 to -0.16 (95% CI: -0.22 to -0.11) in 2021. The inequality was particularly pronounced among females, where CIX values decreased from - 0.21 (95% CI: -0.25 to -0.17) to -0.24 (95% CI: -0.30 to -0.17) during the same period, consistently remaining at a relatively high level. CONCLUSION: The persistent and widening inequalities in HNC, particularly those affecting females and low SDI regions, call for equitable global governance. particularly affecting females and low-SDI regions, necessitate equitable global governance. Addressing this issue necessitates the establishment of robust data systems, the implementation of gender- and region-specific interventions, the bridging of technological and resource gaps, and enhanced cross-sectoral collaboration. This integrated approach is essential for disrupting the low-SDI/high-burden cycle and promoting health equity as a fundamental right.