Suicide risk among cancer survivors: Head and neck versus other cancers.

BACKGROUND: Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC). METHODS: The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis. RESULTS: There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77-2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004. CONCLUSIONS: Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC.

Head and Neck Cancer Incidence in the United States Before and During the COVID-19 Pandemic.

Importance: Research about population-level changes in the incidence and stage of head and neck cancer (HNC) associated with the COVID-19 pandemic is sparse. Objective: To examine the change in localized vs advanced HNC incidence rates before and during the first year of the pandemic. Design, Setting, and Participants: In this cross-sectional study of patients in the US diagnosed with HNC from 2017 to 2020, the estimated number with cancer of the oral cavity and pharynx (floor of mouth; gum and other mouth; lip; oropharynx and tonsil; and tongue) and larynx were identified from the SEER cancer registry. Subgroup analyses were stratified by race and ethnicity, age, and sex. Data were analyzed after the latest update in April 2023. Exposure: The COVID-19 pandemic in 2020. Main Outcomes and Measures: The primary outcomes were the annual incidence rates per 100 000 people for localized HNC (includes both localized and regional stages) and advanced HNC (distant stage) and weighted average annual percentage change from 2019 to 2020. Secondary outcomes included annual percentage change for 2017 to 2018 and 2018 to 2019, which provided context for comparison. Results: An estimated 21 664 patients (15 341 [71%] male; 10 726 [50%] ≥65 years) were diagnosed with oral cavity and pharynx cancer in 2019 in the US, compared with 20 390 (4355 [70%] male; 10 393 [51%] ≥65 years) in 2020. Overall, the HNC incidence rate per 100 000 people declined from 11.6 cases in 2019 to 10.8 in 2020. The incidence rate of localized cancer declined to 8.8 cases (-7.9% [95% CI, -7.5 to -8.2]) from 2019 to 2020. The localized cancer incidence during the first year of the pandemic decreased the most among male patients (-9.3% [95% CI, -9.2 to -9.5]), Hispanic patients (-12.9% [95% CI, -12.9 to -13.0]), and individuals with larynx cancer (-14.3% [95% CI, -13.6 to -15.0]). No change in the overall incidence rate was found for advanced HNC. Conclusions and Relevance: In this cross-sectional study, the incidence of localized HNC declined during the first year of the pandemic. A subsequent increase in advanced-stage diagnoses may be observed in later years.

Incidence of facial fractures in association with facial laceration from dog bites in the pediatric patient.

INTRODUCTION: Dog bite injuries occur in approximately 102 of every 100,000 population. Pediatric facial injuries due to dog bites are more common than in the adult largely due to height difference and ease of access for the dog to the head and neck region. Although majority are soft tissue injuries, pediatric facial fractures from dog bites are estimated at approximately 5%, with the true incidence unknown. We hypothesize that depth and facial subsite of laceration can indicate likelihood of facial fracture presence in pediatric patients with dog bite injuries. METHODS: This single-institution retrospective study included 162 patients 18 years or younger (n = 162) who had an ICD-9 code of E906.0 or ICD-10 code of W54.0 for dog bites in the head and neck region between 1/1/2015 and 12/31/2019 and were treated in the emergency department by either an emergency department, otolaryngology, or plastics surgery provider. Multivariable logistic regressions were used to examine the association between patient age, sex, and dog size, and the outcomes: laceration depth (epidermis, dermis, muscle, bone), and facial subsite (upper, middle, lower third). RESULTS: Males had a lower laceration penetration at the epidermis level (aOR = 0.36; 95% CI 0.19, 0.69) but a higher laceration penetration at the muscle level (aOR = 2.29; 95% CI 1.04, 5.04) compared to females. No significant findings were observed for the levels of dermis and bone. In the multivariable analysis, there were no significant associations to suggest facial fractures found between facial subsites and age, sex and dog size. CONCLUSION: No significant associations between depth or facial subsite of facial injury from dog bites and the presence of facial fractures in pediatric patients except with regard to male sex and laceration level of epidermis and muscle.

Differential Outcomes Among Survivors of Head and Neck Cancer Belonging to Racial and Ethnic Minority Groups.

Importance: Approximately 1 in 5 new patients with head and neck cancer (HNC) in the US belong to racial and ethnic minority groups, but their survival rates are worse than White individuals. However, because most studies compare Black vs White patients, little is known about survival differences among members of racial and ethnic minority groups. Objective: To describe differential survival and identify nonclinical factors associated with stage of presentation among patients with HNC belonging to racial and ethnic minority groups. Design, Setting, and Participants: This population-based retrospective cohort study used data from the 2007 to 2016 Surveillance, Epidemiology, and End Results (SEER) database and included non-Hispanic Black, Asian Pacific Islander, American Indian/Alaska Native, and Hispanic patients with HNC. The data were analyzed from December 2020 to May 2021. Main Outcomes and Measures: Outcomes were time to event measures: (HNC-specific and all-cause mortality) and stage of presentation. Covariates included nonclinical (age at diagnosis, sex, race and ethnicity, insurance status, marital status, and a composite socioeconomic status [SES]) and clinical factors (stage, cancer site, chemotherapy, radiation, and surgery). A Cox regression model was used to adjust associations of covariates with the hazard of all-cause death, and a Fine and Gray competing risks proportional hazards model was used to estimate associations of covariates with the hazard of HNC-specific death. A proportional log odds ordinal logistic regression identified which nonclinical factors were associated with stage of presentation. Results: There were 21 966 patients with HNC included in the study (mean [SD] age, 56.02 [11.16] years; 6072 women [27.6%]; 9229 [42.0%] non-Hispanic Black, 6893 [31.4%] Hispanic, 5342 [24.3%] Asian/Pacific Islander, and 502 [2.3%] American Indian/Alaska Native individuals). Black patients had highest proportion with very low SES (3482 [37.7%]) and the lowest crude 5-year overall survival (46%). After adjusting for covariates, Hispanic individuals had an 11% lower subdistribution hazard ratio (sdHR) of HNC-specific mortality (sdHR, 0.89; 95% CI, 0.83-0.95), 15% lower risk for Asian/Pacific Islander individuals (sdHR, 0.85; 95% CI, 0.78-0.93), and a trending lower risk for American Indian/Alaska Native individuals (sdHR, 0.85; 95% CI, 0.71-1.01), compared with non-Hispanic Black individuals. Race, sex, insurance, marital status, and SES were consistently associated with all-cause mortality, HNC-specific mortality, and stage of presentation, with non-Hispanic Black individuals faring worse compared with individuals of other racial and ethnic minority groups. Conclusions and Relevance: In this cohort study that included only patients with HNC who were members of racial and ethnic minority groups, Black patients had significantly worse outcomes that were not completely explained by stage of presentation. There may be unexplored multilevel factors that are associated with social determinants of health and disparities in HNC outcomes.

Prevalence and Factors Associated With Oral Cavity and Pharyngeal Cancer Screening in a Rural Population.

OBJECTIVE: (1) To quantify the prevalence of provider recommendation and receipt of oral cavity and pharyngeal cancer (OCPC) screening and (2) to examine the factors associated with OCPC screening recommendation and receipt among adults. STUDY DESIGN: Cross-sectional. SETTING: Rural counties in central Illinois. METHODS: This study among adults (N = 145) was conducted between January 1 and June 30, 2017. The outcomes of interest were provider recommendation and receipt of OCPC screening. Multivariable logistic regression models were used to examine the association between (1) sociodemographic, health care access and utilization, and OCPC risk factors and (2) provider recommendation and receipt of OCPC screening. RESULTS: The prevalence of provider recommendation and receipt of OCPC screening was 12.4% and 28.3%, respectively. Approximately 15% of current smokers, 13% of participants who consume alcohol, and 10% of participants with ≥5 lifetime sexual partners had received an OCPC screening recommendation. OCPC screening rates were 19% for current smokers, 30% for those who consume alcohol, and 32% for those with ≥5 lifetime sexual partners. In the adjusted analyses, respondents with ≥5 partners (adjusted odds ratio, 3.10 [95% CI, 1.25-7.66]) had a higher odds of receiving OCPC screening than those with <5. There were no significant associations between other OCPC risk factors and provider recommendation and receipt of OCPC screening. CONCLUSION: OCPC screening recommendation and receipt were low; only number of lifetime sexual partners was associated with OCPC screening receipt. Our findings suggest that rural populations may be vulnerable to late-stage diagnosis of OCPC, and interventions to help improve screening rates are warranted.

Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina.

The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions-the social deprivation index (SDI). Data were analyzed using chi-square tests, Student's t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02-1.10), African American race (OR = 1.35, 95% CI: 1.29-1.41), and being unmarried (OR = 1.17, 95% CI: 1.13-1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.

Armed Conflict in Central America and Immigrant Food Insecurity in the United States.

Central American immigrants to the United States are a growing population with rates of food insecurity that exceed national averages. We analyzed multiple years of data from the Center for System Peace and the Current Population Survey, Food Security Survey Module, from 1998 to 2015. We used ordered probit and probit regressions to quantify associations between premigration residence in a country exposed to armed conflict in Central America and the food insecurity of immigrants in the United States. The study sample included 5682 females and 5801 males between the ages of 19 and 69 years who were born in Central America and migrated to the United States. The mean age of individuals included in the study sample was 38.2 years for females (standard deviation, 11.0) and 36.8 years for males (standard deviation, 10.6). Premigration armed conflict was associated with a 10.7% point increase in postmigration food insecurity among females (95% confidence interval, 6.8-14.5), and a 9.5% point increase among males (95% confidence interval, 5.0-14.0).

Peace in Guatemala and Immigrant Health in the United States.

BACKGROUND: The civil war between the indigenous Mayans and other Guatemalans lasted for 36 years, killed civilians, decimated villages, and resulted in many refugees. The Guatemalan Peace Agreement of 1996 aimed to alleviate the ongoing conflict. Studies of peace agreements more typically evaluate local political outcomes while neglecting global health outcomes. OBJECTIVE: Our research quantified associations between pre-migration exposure to the peace agreement in Guatemala and the post-migration health status of Guatemalan immigrants in the United States. METHODS: We used chi-square tests to compare the distribution of health status before and after peace. We used ordered probit regressions to estimate associations between peace in Guatemala and health in the United States, conditional on the observed distributions of age, age squared, age cubed, and linear time trends before and after peace. FINDINGS: The study sample included 4,115 female and 5,282 male Guatemalan immigrants between the ages of 15 and 85. The mean age was 38.8 years for females (standard deviation, 14.2) and 35.4 years for males (standard deviation, 12.6). Chi-square tests found statistically significant differences in the distribution of health status before and after the peace agreement, for females (P < .001) and males (P < .001). In unadjusted results, the peace agreement was associated with a 7.3 percentage point increase in excellent post-migration health for females (95% confidence interval, 4.9 to 9.8) and a 6.0 percentage point increase for males (95% confidence interval, 3.8 to 8.2). In adjusted results, we found that the peace agreement was associated with a 6.1 percentage point increase in excellent post-migration health for females (95% confidence interval, 0.8 to 11.4) and a 5.5-percentage point increase for males (95% confidence interval, 1.0 to 10.0). CONCLUSIONS: The peace agreement in Guatemala was associated with statistically significant improvements in the health status of Guatemalan immigrants to the United States.

Patent foramen ovale closure versus medical therapy in cases with cryptogenic stroke, meta-analysis of randomized controlled trials.

BACKGROUND: PFO is more common in cases with cryptogenic stroke compared to cases with no stroke or stroke of identified etiology. Several randomized controlled trials (RCTs) comparing PFO closure with medical therapy have been published with controversial findings. METHODS: PubMed, Embase and Cochrane library databases were searched for RCT comparing PFO closure with medical therapy including antiplatelet therapy (aspirin or clopidogrel or combination) or anticoagulation. We identified 5 trials, including 3627 cases. The mean duration of follow-up was 4 years. Relative risk (RR) and 95% confidence intervals (CI) were calculated using fixed and random-effects models. RESULTS: There was a significant reduction in the incidence of stroke among the PFO closure group compared to medical therapy group, 2.0 versus 4.2%, RR 0.48; 95% CI (0.3, 0.7), p < 0.001. The incidence of AF was higher in the PFO closure group compared to medical therapy group, 4.2 versus 0.7%, respectively, RR 5.9, 95% CI (3, 11), p < 0.001. After exclusion of oral anticoagulants cases (19%), analysis showed a lower incidence of stroke in the PFO closure group (2%) compared to antiplatelet therapy (5.2%), RR 0.4; 95% CI (0.3, 0.6), p < 0.001. There was no significant difference between both groups in the incidence of transient ischemic attacks or all-cause deaths. CONCLUSION: PFO closure results in a significant reduction in the recurrence of ischemic stroke compared to medical therapy alone, primarily antiplatelet, among cases with PFO and cryptogenic stroke.

Self-Reported Lifetime Depression and Current Mental Distress Among Veterans Across Service Eras.

INTRODUCTION: Limited research exists comparing the prevalence of lifetime depression and current mental distress between veterans and nonveterans by military service era. We compared the prevalence of self-reported lifetime depression and current mental distress between veterans and nonveterans of the World War II, Korea, Vietnam, and Gulf War eras. METHODS: Data from the 2012 Behavior Risk Factor Surveillance System were analyzed for 243,561 survey participants aged 18 years and older. Separate multivariable logistic regression models were computed for each service era to estimate the association between veteran status and lifetime depression and current mental distress. RESULTS: Lifetime depression was lower among veterans vs. nonveterans who served in the military during World War II era (adjusted odds ratio [aOR] = 0.54; 95% confidence interval [CI] = 0.43-0.66) and the Korean War era (aOR = 0.50; 95% CI = 0.42-0.59) but higher among veterans vs. nonveterans of the Vietnam War era (aOR = 1.39; 95% CI = 1.43-1.73). Similarly, current mental distress was lower among veterans vs. nonveterans of the World War II era (aOR = 0.56; 95% CI = 0.44-0.71) and the Korean War era (aOR = 0.47; 95% CI = 0.37-0.60) but higher among veterans vs. nonveterans of the Vietnam War era (aOR = 1.14; 95% CI = 1.02-1.28). CONCLUSION: Both lifetime depression rates and current mental distress differed among veterans compared to nonveterans within each service era. Understanding the burden of depressive disorder among veterans of all eras may facilitate efficient and effective treatment and allocation of mental health care resources.