Investigating Disparities in Hypopharyngeal/Laryngeal Cancer Survival in Florida With Geospatial Mapping Analysis.

OBJECTIVE: Identify predictors of overall survival (OS) after hypopharyngeal/laryngeal cancer in Florida. MATERIAL AND METHODS: We conducted a retrospective cohort study using data from the Florida Cancer Data System (FCDS) on patients diagnosed with hypopharyngeal or laryngeal cancer from 2010-2017. Primary outcome was OS. Hazard ratios (HRs) were estimated from univariable and multivariable Cox regression models for OS. Data was analyzed from November 1, 2022, to June 30, 2023. RESULTS: We analyzed 6771 patients, who were primarily male (81.2%), White non-Hispanic (WNH) (78.2%), publicly insured (70.1%), married (51.8%), and residents of urban counties (73.6%). Black patients were more likely to be younger at diagnosis (38.9%), single (43.4%), to have distant SEER stage disease (25.6%). Median OS were lowest among patients who were uninsured (34 months), with hypopharyngeal site disease (18 months), and a smoking history (current: 34 months, former: 46 months, no smoking: 63 months). Multivariable Cox regression analysis showed worse OS for single/unmarried vs married (HR 1.47 [95%CI: 1.36-1.59], P < .001), history of tobacco use (current: HR 1.62 [95%CI: 1.440-1.817], P < .001; former smokers: (HR 1.28 [95%CI: 1.139-1.437], P < .001) vs no history). Improved OS was observed among White Hispanics (WH) vs WNH (HR .73 [95%CI: .655-.817], P < .001) and women vs men (HR .88 [95%CI: .807-.954], P = .002). Geographical mapping showed that mortality rates were highest in census tracts with low income and education. CONCLUSION: Our findings suggest that sociodemographic and clinical factors impact OS from hypopharyngeal/laryngeal cancer in Florida and vary geographically within the state. These results will help guide future public health interventions.

Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An ecological study of social vulnerability in Miami-Dade county.

Neighborhoods have been identified as important determinants of health-related outcomes, but limited research has assessed the influence of neighborhood context along the cancer continuum. This study used census tract-level data from the United States Census Bureau and Centers for Disease Control and Prevention to characterize Miami-Dade County census tracts (n = 492) into social vulnerability clusters and assess their associated breast, cervical, and colorectal cancer screening participation rates. We identified disparities by social vulnerability cluster in cancer screening participation rates. Further investigation of geographic disparities in social vulnerability and cancer screening participation could inform equity-focused cancer control efforts.

Intersectional disparities in climate vulnerability and cancer risk.

Despite significant progress in the early detection, treatment, and survivorship of cancer in recent decades, cancer disparities continue to plague segments of the US population. Many of these cancer disparities, especially those among historically marginalized racial and ethnic groups and those with lower socioeconomic resources, are caused and perpetuated by social and structural barriers to health. These social and structural barriers, which operate beyond the framework of cancer control, also systematically increase vulnerability to and decrease adaptive capacity for the deleterious effects of anthropogenic climate change. The established and emerging overlap between climate vulnerability and cancer risk presents complex challenges to cancer control, specifically among populations who suffer compounding hazards and intersectional vulnerabilities. By embracing these intersections, we may be able to conceptualize promising new research frameworks and programmatic opportunities that decrease vulnerability to a wide range of climate and health threats to advance health equity.

Perceptions of Practitioner Support for Patient Autonomy are Associated with Delayed Health Care Seeking among Haitian Immigrant Women in South Florida.

Few empirical studies have evaluated how perceptions of the patient-provider relationship affect health care seeking among Haitian immigrants. In this cross-sectional study, we examined whether perceptions of practitioner support for patient autonomy facilitate or hinder health care seeking among Haitian women enrolled in a cervical self-sampling trial. Perceived autonomy support was measured using an adapted health care climate questionnaire. Associations between perceived autonomy support and health care seeking were modeled using logistic regression and classification and regression trees. Covariates included socioeconomic and structural access indicators. Dependent variables included receipt of any medical care in the past year and delayed health care seeking. Having a usual source of care was strongly associated with both dependent variables. Lower perceived autonomy support was associated with delayed health care seeking in regression models and classification and regression trees. Addressing the capacity of health workers to deliver autonomy-supportive care is essential for improving health services utilization in vulnerable populations.

Racial and ethnic disparities in the overall survival of women with epithelial ovarian cancer in Florida, 2001-2015.

Many studies have focused on white and black disparities in epithelial ovarian cancer (EOC) but fewer include Hispanics. Florida presents a unique opportunity to study racial/ethnic disparities. This study examined racial/ethnic disparities in the overall survival of women with EOC in Florida by histology. All EOC cases from 2001 through 2015 were identified in the Florida Cancer Database System (FCDS). Survival curves by race/ethnicity and histology were generated by Kaplan-Meier methods. Cox regression evaluated the associations between race/ethnicity, histology, and survival. Eligible EOC cases (n = 21,721) identified in the 2001-2015 FCDS were included in the study. The median survival for non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics was 31, 21, and 35 months, respectively (p < 0.001). NHB had an increased [AHR 1.23 (95% CI 1.15, 1.30)] and Hispanics a nonsignificant decreased hazard [AHR 0.96 (95% CI 0.91, 1.02)] of death compared to NHW after controlling for other demographic, treatment, and tumor characteristics. Relative to NHWs, NBH had worse survival while Hispanics had equivalent survival. Future research should consider evaluating genetic and epigenetic modifications, and prevalence of cancer syndromes to further elucidate the etiologies of disease in these disparate populations.

Epidemiology and Etiology of Leukemia and Lymphoma.

Available evidence suggests that the incidence of leukemia and lymphoma tends to be higher in highly developed regions of the world and among Whites in the United States. Temporal trends in incidence are dynamic and multifactorial; for instance, the incidence of non-Hodgkin's lymphoma increased around the turn of the century, in part because of the acquired immune deficiency syndrome (AIDS) epidemic. Most leukemias and lymphomas are sporadic and the specific etiology remains elusive. Still, research shows that these malignancies often develop in the context of genetic abnormalities, immunosuppression, and exposure to risk factors like ionizing radiation, carcinogenic chemicals, and oncogenic viruses. The prognosis varies by subtype, with poorer survival outcomes for acute leukemias among adults, and more favorable outcomes for Hodgkin's lymphoma. At a time when specific prevention efforts targeting these malignancies are nonexistent, there is a great need to ensure equitable access to diagnostic services and treatments worldwide.