Age-standardized incidence and mortality rates of oral and pharyngeal cancer in Puerto Rico and among Non-Hispanics Whites, Non-Hispanic Blacks, and Hispanics in the USA

Abstract

Background: In the American region, Puerto Rico (PR) has the highest incidence of oral and pharyngeal cancer (OPC), but racial/ethnic differences have never been assessed and compared with other groups in the United States of America (USA). We compared the age-adjusted incidence and mortality rates of OPC between PR and among USA Hispanics (USH), Non-Hispanic Whites (NHW), and Non-Hispanic Blacks (NHB) to assess the burden of this cancer in PR.

Methods: Analysis of the age-standardized rates (per 100,000) was performed using the direct method with the world standard population (ASR(World)) from 1998-2002. Annual percent change (APC) and Relative Risks (RR) were calculated using the Poisson regression model.

Results: The incidence ASR(World) for men in PR was constant (APC approximately 0.0%), in contrast, a decrease was observed among NHW, NHB, and USH men, although only USH showed statistical significance (APC = -4.9%, p < 0.05). In women, the highest increase in incidence (APC = 5.3%) and the lowest decrease in mortality (APC = -1.4%) was observed in PR. The ratio of the ASR(World) showed that in all racial/ethnic groups, men had approximately 2-4 fold increased incidence and mortality risk of OPC than women (p < 0.05). Men in PR had a higher mortality risk (p < 0.05) of OPC as compared to USH, NHW, and NHB; but among women, PR showed a significant excess of mortality only as compared to USH (est. SRR = 1.82, 95% CI = 1.41, 2.33).

Conclusion: The overall higher incidence of OPC in men in PR as compared to USH, NHB, and NHW could be explained by the effect of gene-environment interactions. Meanwhile, the higher mortality from OPC in PR suggests limitations in the health-care access within this population. Further research is warranted to elucidate these findings.

Figure 1

Annual ASR (World) for oral and pharyngeal cancer incidence and mortality, 1998–2002.

Figure 2

Relative Risks' (95% CI) for incidence and mortality of oral and pharyngeal cancer in the Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB), and the USA Hispanics (USH) when compared to Puerto Rico, 1998–2002.